Indian Journal of Ophthalmology

CASE REPORT
Year
: 1998  |  Volume : 46  |  Issue : 4  |  Page : 252--253

Anterior dislocation of foldable silicone lens


S Khokhar, N Dhingra 
 Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Ophthalmic Sciences, New Delhi, India

Correspondence Address:
S Khokhar
Dr. Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, New Delhi -110 029
India




How to cite this article:
Khokhar S, Dhingra N. Anterior dislocation of foldable silicone lens.Indian J Ophthalmol 1998;46:252-253


How to cite this URL:
Khokhar S, Dhingra N. Anterior dislocation of foldable silicone lens. Indian J Ophthalmol [serial online] 1998 [cited 2022 Oct 2 ];46:252-253
Available from: https://www.ijo.in/text.asp?1998/46/4/252/24175


Full Text

The advent of phacoemulsification and foldable intraocular lens (IOL) has permitted early rehabilitation, earlier stabilization of refraction and reduction in induced astigmatism. Foldable lens, as the term implies, can be folded by the help of special instruments like forceps[1] or cartridges and can be inserted through an incision smaller than their optic size. Because of the soft and compliant nature of these lenses, there is potential for damage to the optics and haptics, resulting in possible post-operative visual problems. This communication is to report a rare complication of a foldable silicone lens becoming anteriorly dislocated following a minor trauma.

 Case Report



A 45-year-old female patient came to us complaining of diminished vision in the left eye, after receiving a minor trauma to the head. She had slipped in the kitchen and banged her head on the shelf. There was no direct trauma to either of the eyes. The patient's history included a sutureless cataract surgery in the same eye one year before with good postoperative visual recovery.

On examination, the right eye was found to be normal. The left eye had visual acuity of 3/60, and there was diffuse corneal edema inferiorly. This edema was mostly stromal. An intraocular lens (IOL) was seen in the anterior chamber corresponding to the corneal edema [Figure1]. The IOL was freely mobile but no haptics could be seen on slitlamp examination. On dilatation of pupil the intact capsulorrhexis margin could be clearly seen. The patient was taken up for surgery under peribulbar block using lignocaine (2%) plus bupivacaine (0.5%) and hylase (150 I.U.). The IOL was removed by viscoexpression after making a 7 mm limbal incision. A thorough search was done for the broken haptics but it was not found inside the eye. A 7.0 mm polymethyl methacryalate (PMMA) posterior chamber IOL was implanted in the capsular bag after inflating it with viscoelastic. The patient had a postoperative visual acuity of 6/12 at discharge. The explanted IOL was a 6.0 mm optic size silicone foldable lens.

 Discussion



Silicone foldable IOLs have been used in cataract and implant surgery since 1984. Key characteristics of silicone IOLs are flexibility and compressibility of the optic, traits that enable surgeons to insert the lens through a small incision. Other benefits resulting from combination of small-incision surgery and foldable IOL include decreased postoperative inflammation, less astigmatism and early rehabilitation.

Because of their flexible nature, the insertion of soft lenses is somewhat different and requires additional training for surgeons who routinely implant rigid PMMA lenses. As interest in small-incision cataract surgery has increased, devices to facilitate insertion through smaller incisions have been developed. The first-generation folding devices like bar holders and second-generation devices like tube holders are not complication-free and rare cases of broken and scratched lenses have been reported.[2],[3] Newman and associates4 in their pathology report of an explanted silicone plate lens, demonstrated the presence of several grooves and indentations on the surface of the lens. We did not come across any cases of anterior dislocation of foldable lens in the literature, thus making this the first case report of its kind. We wish to emphasize that proper precautions should be taken while implanting foldable lenses and implants with damaged or broken haptics should be disarded.

We think that this dislocation occurred mainly due to the absence of the haptics which may have broken during insertion of the IOL, as no haptics were seen in the eye during the surgery[4].

References

1Faulkner GD. Folding and inserting silicone IOL implants. J Cat Ref Surg 1987;13:678-81.
2Habib NE, Singh I, Adams AD, Bartholomew RD. Cracked cartridges during foldable IOL implantation. J Cat Ref Surg 1996;22:630-32.
3Vrabee MP, Syverid JC, Burgess CJ. Forceps induced scratching of a foldable acrylic IOL. Arch Ophthalmol 1996;114:772.
4Newman DA, McIntyre DJ, Apple DJ, Popham JK, Isenberg RA. Pathologic findings of an explanted silicone intraocular lens. J Cat Ref Surg 1986;12:292-97.