A case of spontaneous bilateral in-the-bag intraocular lens (IOL) anterior partial dislocation following a routine annual eye examination

Session Details

Session Title: Presented Poster Session 10: Cataract Surgery Special Cases

Session Date/Time: Sunday 14/09/2014 | 15:00-17:00

Paper Time: 15:00

Venue: Pod 1 (Poster Village)

First Author: : J.Ford USA

Co Author(s): :    L. Werner   L. Owen   S. Vasavada   A. Crandall     

Abstract Details

Purpose:

We present the case of an 81-year-old gentleman with pseudoexfoliation syndrome (PXE) who was diagnosed with spontaneous bilateral in-the-bag intraocular lens (IOL) anterior partial dislocation following a routine dilated examination that demonstrated only mild pseudophacodonesis without evidence of subluxation. Notably, the patient underwent uncomplicated bilateral cataract surgery seven years prior with placement of single-piece hydrophobic acrylic posterior chamber (PC)-IOLs.

Setting:

John A. Moran Eye Center, University of Utah, Salt Lake City, UT, USA.

Methods:

Prior to the dislocation event, each annual dilated eye examination had been normal. The patient’s uncorrected visual acuity (UCVA) was 20/30+2 OD and 20/40-1 OS, and best-corrected visual acuity (BCVA) was 20/20 OD and 20/25 OS (manifest refraction: -2.25 +1.75 175° OD; -1.75 +2.00 162° OS). Four days after this examination, the patient reported blurry vision. His UCVA was 20/100 OD and 20/100 OS. Slit lamp examination was remarkable for bilateral anterior partial in-the-bag IOL dislocation. The patient underwent bilateral IOL repositioning with scleral fixation. Briefly, in OD two paracentesis wounds were created. Micrograspers were then used to position the lens, such that the needle containing 9-0 Prolene could be passed around the haptic using a paracentesis wound. This was initially done nasally; the haptic was appropriately lassoed and the suture tied through sclerotomy sites created approximately 2.5 mm from the limbus. This procedure was done for both haptics. A similar technique was used in OS.

Results:

Following scleral fixation, on postoperative day 1, the IOLs were well-centered within the capsular bag bilaterally. UCVA was 20/40 OD and 20/70 OS. On postoperative week 2, UCVA was 20/40 OD and 20/80 OS. There was no change in visual acuity of the right eye, but the left eye corrected to 20/40 (manifest refraction: -1.00 +1.75 41° OS; -1.25 +0.75 164° OD ). The IOLs were well-centered in the undilated state in both eyes with no evidence of inflammation. At postoperative month 1, UCVA was 20/30-1 OD and 20/70 OS. BCVA was 20/20-1 OD and 20/25-2 OS (manifest refraction: -1.00 +1.25 5° OD; -1.75 +1.75 175° OS). The patient’s intraocular pressure (IOP) was stable prior to and following IOL dislocation.

Conclusions:

Patients who have PXE or connective tissue disorders such as Marfan’s syndrome, homocystinuria, hyperlysinemia, Ehler-Danlos, scleroderma, and Weil-Marchesani, or who have a history of prior vitreoretinal surgery or a history of trauma, are predisposed to IOL dislocation. As our case demonstrates, spontaneous in-the-bag bilateral IOL subluxation/dislocation can occur after a routine eye examination, presumably secondary to PXE-induced zonular weakness and precipitated by pupillary dilation. To the best of our knowledge, this is the first report of bilateral IOL dislocation occurring in the setting of a routine dilated eye examination.

Financial Interest:

NONE