Case Reports

Malposition of an Intraocular Lens (IOL) as an underlying cause of monocular polyopia: a case report

Case Report Details

First Author: M.Cruz Rojo SPAIN

Co Author(s):    F. Hermoso Fernández   M. Gascón Ginel   J. García Serrano   R. Martínez Castillo   M. Lindez Pérez de Andrade   L. Mesones Ruíz     

Abstract Details

Purpose:

To describe an infrequent but possible complication of the cataract surgery such as the malposition of an IOL as an underlying cause of polyopia.

Setting:

Department of Ophthalmology of the San Cecilio University Hospital of Granada, Spain.

Report of Case:

A 68 year old woman with history of a significant degree of anisometropia, who underwent cataract surgery in her left eye with an IOL implantation and who developed postsurgical uveitis as a posterior complication due to non-adherence to treatment, presented with a chief complaint of persistent monocular polyopia in her left eye (triple vision) eight months after the surgery. The best corrected visual acuity (BCVA) was OS = 6/7.5 but with triple vision, and the slit-lamp examination revealed temporarily subluxated and tilted IOL. The nasal haptic was inside the bag and the rest of the lens was in sulcus. Without dilated pupil the root of the haptic was seen in the pupillary area and one-third of the pupillary area was not occupied by the lens. The capsule was intact but there were synechiae in the anterior and posterior capsule. Possibility of surgery with emphasis on uncertain anatomical and functional prognosis was explained, which the patient understood and accepted. A second surgery was performed with the explant of the first lens and an implantation of a +9D lens in sulcus without any complications during the procedure. The day after surgery, an improvement of the symptomatology was observed, without the presence of polyopia, the BCVA in OS was 6/10 and the slit-lamp examination revealed a centered IOL in sulcus. The same clinical findings, with the exception of a BCVA in OS = 6/7.5, were exposed fifteen days after the surgery.

Conclusion/Take Home Message:

'- Polyopia after cataract surgery is an unexpected outcome, and the determination of the etiology is important as the treatment is usually directed towards the cause. - An IOL displacement should be considered as a cause of polyopia, especially when the pupillary area is not fully covered by the optic of the lens or the lens is tilted. - Uncertain anatomical and functional prognosis should be taken into consideration when a second intervention is proposed, as well as the discomfort of the syntomatology presented.

Financial Disclosure:

None