Case Reports

Capsular disintegration and intraocular lens (IOL) dislocation secondary to anterior uveitis after cataract surgery and multifocal IOL implantation

Case Report Details

First Author: C.Mendez SPAIN

Co Author(s):    C. Mendez   B. Salvador   R. Barraquer   E. Barraquer           

Abstract Details

Purpose:

We present the first case of capsular disintegration after anterior uveitis with intraocular lens (IOL) dislocation to vitreous chamber.

Setting:

There are multiple causes of IOL dislocation after cataract surgery. These can be divided into dislocations with or without capsular bag. The present case reports a dislocation of the IOL to the vitreous chamber due to the disintegration or disappearance of the capsular bag after mild anterior uveitis.

Report of Case:

A 49-year-old man underwent uneventful cataract surgery with a multifocal IOL implant in the bag. Seven days later, the patient presented visual acuity (VA) without correction of 1.0 (decimal) for both distant (DVA) and near vision in both eyes. At 6 weeks, he suffered a mild anterior uveitis without affecting visual acuity, which resolved within a few days with topical corticosteroid treatment. Ten days later the patient presented an uncorrected VA of 0.3 for DV, improving to 1.0 with a hyperopic correction of +2.0D. On examination, the IOL was displaced posteriorly and slightly towards the inferior-temporal quadrant; the absence of the capsular sac is also evident. Ultrasound of the anterior segment confirmed the IOL in place but luxated in its antero-posterior axis. At this point we decided to explant the IOL and capsular bag and suture a new IOL to the sclera. During surgery, the remains of the capsular sac could not be found, and the IOL was slightly displaced towards the inferior temporal sector and lying on the anterior hyaloid of the vitreous body, which was intact and completely transparent (video). The initial plan had to be reevaluated and the IOL was removed and a new monofocal sulcus IOL was implanted, without any complications. Upon direct inspection, there was no evidence of any alteration, impregnation, opacity or defect of the IOL or any evident focus of infection in the anterior or vitreous chambers. The culture of the explanted IOL was negative. At the 1-year follow-up, uncorrected DVA had returned to 1.0.

Conclusion/Take Home Message:

As uveitis occured 6 weeks after cataract surgery, without any confirmed cause, the patient's prompt consultation after the onset of symptoms (1 day), the absence of recurrence of uveitis and the lack of findings of any infectious origin suggest that the relationship of uveitis with the surgery or the implanted IOL themselves might be excluded. In addition, there were no othe reported issues with any of the other the IOLs implanted in the same surgical session that day, or in the implantation of the same type of IOL in the contralateral eye. Therefore, this may be the first case of in which an anterior uveitis reaction disintegrates the capsular sac, suggesting the need for a more in-depth study of postoperative inflammation after cataract surgery and its relationship with intraocular tissues.

Financial Disclosure:

None