A unique case of haptic protusion from iris after neodymium-yttrium aluminum garnet laser capsulotomy

Kalluri Satya Srividya; S Balamurugan; Snigdha Mishra; R Venkatesh

doi:10.4103/IJO.IJO_2871_22

CASE REPORT

Year : 2023 | Volume : 3 | Issue : 2 | Page : 335-336

A unique case of haptic protusion from iris after neodymium-yttrium aluminum garnet laser capsulotomy

Kalluri Satya Srividya¹, S Balamurugan², Snigdha Mishra¹, R Venkatesh³
¹ Senior Resident, Aravind Eye Hospital, Pondicherry, India
² Medical Consultant, Uvea Services, Aravind Eye Hospital, Pondicherry, India
³ Chief Medical Officer, Consultant, Glaucoma Services, Aravind Eye Hospital, Pondicherry, India

Date of Submission	29-Oct-2022
Date of Acceptance	10-Jan-2023
Date of Web Publication	28-Apr-2023

Correspondence Address:
S Balamurugan
C/O Aravind Eye Hospital, Cuddalore Main Road, Thavalakuppam, Pondicherry - 605007
India

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/IJO.IJO_2871_22

Abstract

Neodymium-ytrrium aluminium garnet capsulotomy is the gold standard for the treatment of posterior capsular opacification and is most commonly performed as an outpatient procedure. Here, the authors report a rare and probably the first encounter of a complication post laser capsulotomy seen in a 54 years old female who presented with defective vision and pain for 6 months after the procedure. Examination revealed one of the haptics of intraocular lens piercing through the iris into the anterior chamber, causing chronic inflammation leading to cystoid macular edema. The exact position of the intraocular lens and it's haptics were confirmed using anterior segment optical coherence tomography.

Keywords: Cystoid macular edema, laser capsulotomy, posterior capsular opacification

How to cite this article:
Srividya KS, Balamurugan S, Mishra S, Venkatesh R. A unique case of haptic protusion from iris after neodymium-yttrium aluminum garnet laser capsulotomy. Indian J Ophthalmol Case Rep 2023;3:335-6

How to cite this URL:
Srividya KS, Balamurugan S, Mishra S, Venkatesh R. A unique case of haptic protusion from iris after neodymium-yttrium aluminum garnet laser capsulotomy. Indian J Ophthalmol Case Rep [serial online] 2023 [cited 2023 Jun 10];3:335-6. Available from: https://www.ijoreports.in/text.asp?2023/3/2/335/374993

Neodymium-ytrrium aluminium garnet (Nd:YAG) laser capsulotomy is the most common and widely acknowledged approach for disrupting the opacified posterior capsule.^[1] Although considered noninvasive and safe, it is not without any adverse effects. In this segment, we would linke to enlist an uncommon complication encountered as an aftereffect of this procedure.

Case Report

A 54-year-old female presented with blurring of vision in her right eye (OD) for the past 3 months. The best corrected visual acuity (BCVA) in OD was 6/36 and in the left eye (OS) was 6/18p. The OD showed pseudophakia with posterior capsular opacification (PCO) and the OS had immature cataract. Patient was advised Nd:YAG capsulotomy in OD. The size of opening done was 4 mm, with 26 spots of power 1.2 mJ/spot. Anti-inflammatory eye drops were prescribed with a 1-week follow-up. Patient failed to follow-up until 6 months and presented with pain in OD. There was no history of trauma after the procedure. A thorough anterior and posterior segment evaluation revealed one of the haptics of intraocular lens (IOL) piercing through the iris into the anterior chamber [Figure 1], causing chronic inflammation leading to cystoid macular edema (CME). The exact position of the IOL and its haptics were confirmed using anterior segment optical coherence tomography (AS-OCT) [Figure 2]. The patient was advised corrective surgery and was given a posterior subtenon steroid injection to reduce inflammation.

Figure 1: Right eye slit-lamp image showing IOL haptic protruding through the iris marked by red arrow. IOL = intraocular lens

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Figure 2: Right eye AS-OCT image of the corresponding iris defect (marked as red arrow) showing haptic protrusion into the anterior chamber. AS-OCT = anterior segment optical coherence tomography

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Discussion

Although complications including refractive alterations, IOL movement, damage to IOL, pupillary block glaucoma, retinal hemorrhage, endocapsular spreading of low-grade endophthalmitis, and secondary closure of capsulotomy aperture have been reported in isolation,^[2] to the best of our knowledge, this complication was encountered for the first time. It is not uncommon to see CME following IOL placement in sulcus, either accidentally or due to lack of support.^[3] A similar case of iris epithelial detachment has been reported; however, haptic protusion was not observed.^[4]

Conclusion

A thorough examination and suspicion for IOL position along with Anterior Segment OCT (AS-OCT) is necessary in cases of unexplained Cystoid Macular Edema (CME) and inflammation in post-operative cases.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1.	Aslam TM, Devlin H, Dhillon B. Use of Nd:YAG laser capsulotomy. Surv Ophthalmol 2003;48:594-612. doi: 10.1016/j.survophthal.2003.08.002. PMID: 14609706.
2.	Karahan E, Er D, Kaynak S. An overview of Nd:YAG laser capsulotomy. Med Hypothesis Discov Innov Ophthalmol 2014;3:45-50.
3.	Chang DF, Masket S, Miller KM, Braga-Mele R, Little BC, Mamalis N, et al. ASCRS Cataract Clinical Committee. Complications of sulcus placement of single-piece acrylic intraocular lenses: Recommendations for backup IOL implantation following posterior capsule rupture. J Cataract Refract Surg 2009;35:1445-58.
4.	Jakobsen TS, Kaya MY, Hjortdal JØ, Ivarsen AR. Iris epithelium detachment-An uncommon complication of Nd:YAG laser capsulotomy. Am J Ophthalmol Case Rep 2021;23:101122. doi: 10.1016/j.ajoc.2021.101122.