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LETTER TO EDITOR
Year : 2007  |  Volume : 55  |  Issue : 2  |  Page : 161-162

Fracture of an implanted posterior chamber intraocular lens after trivial trauma in a child


Department of Ophthalmology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India

Correspondence Address:
Jagat Ram
Department of Ophthalmology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0301-4738.30724

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How to cite this article:
Sachdev N, Brar GS, Sukhija J, Ram J. Fracture of an implanted posterior chamber intraocular lens after trivial trauma in a child. Indian J Ophthalmol 2007;55:161-2

How to cite this URL:
Sachdev N, Brar GS, Sukhija J, Ram J. Fracture of an implanted posterior chamber intraocular lens after trivial trauma in a child. Indian J Ophthalmol [serial online] 2007 [cited 2019 Aug 21];55:161-2. Available from: http://www.ijo.in/text.asp?2007/55/2/161/30724

Dear Editor,

Traumatic fracture of anterior chamber Intra ocular lens (IOL) has been commonly reported, but fracture of a posterior chamber (PC) IOL is extremely rare.[1],[2],[3] A 5-year-old male boy underwent right eye phacoaspiration, posterior continuous curvilinear capsulorrhexis, anterior vitrectomy with PCIOL implantation (polymethyl methacrylate - 6 mm optic/12.0 mm overall diameter) for traumatic cataract. The IOL was placed in the ciliary sulcus. Post-operative period was uneventful except for development of 180° pupillary capture of IOL optic within 3 months after surgery.

After 3 years, the child presented with pain and redness in the right eye of 1 week duration. On examination, his best-corrected visual acuity was counting fingers close to face in the right eye and the IOL optic, with fracture at both optic-haptic junctions, was lying in the anterior chamber [Figure - 1]. The child's father admitted to slapping the child lightly on his left cheek prior to the start of this problem. However, there was no history of any direct trauma to the right eye. Subsequently the broken IOL (including its haptics) was removed and a secondary IOL was implanted in the sulcus. Because of strong adhesions between the iris and the capsule, opening the ciliary sulcus for secondary IOL implantation was difficult and was achieved using Healon GV® and sweeping technique of synechiolysis. Intraoperatively there was no evidence of any trauma to other intraocular structures. Post-operatively the visual acuity recovered to 20/60.

Spontaneous fracture of PCIOL has been reported earlier, including a single report of a sulcus fixated PMMA PCIOL in a child.[1] A mechanical weakening, commonly attributed to a defective lens production or repetitive movements of the IOL during pseudoaccommodative effort,[4] has been proposed as the underlying cause. Moreover, in children, extensive fibrosis around the IOL can induce torsion at the optic haptic junction.[1] Perhaps a sudden anterior movement of the vitreous due to a rapid head movement induced by trauma, in the setting of a relatively fixed pupillary captured IOL, broke the IOL at its already stressed optic-haptic junction, which resulted in optic lying in the anterior chamber. Possibility of this complication must be explained to parents of children with similar ocular status as this case.

 
  References Top

1.
Caca I, Unlu K, Ari S, Aksit I. Spontaneous fracture of an implanted posterior chamber intraocular lens. Eur J Ophthalmol 2005;15:507-9.  Back to cited text no. 1
[PUBMED]    
2.
Fujishima K, Yoshitomi F, Oshika T. Spontaneous disinsertion of a haptic from a 3-piece acrylic foldable intraocular lens after surgery. J Cataract Refract Surg 2002;28:1296-8.  Back to cited text no. 2
[PUBMED]  [FULLTEXT]  
3.
Por YM, Chee SP. Spontaneous disinsertion of a multipiece foldable acrylic intraocular lens haptic 3 and 12 months after implantation. J Cataract Refract Surg 2004;30:1139-42.  Back to cited text no. 3
[PUBMED]  [FULLTEXT]  
4.
Altan-Yaycioglu R, Gozum N, Gucukoglu A. Pseudo-accommodation with intraocular lenses implanted in the bag. J Refract Surg 2002;18:271-5.  Back to cited text no. 4
[PUBMED]    


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