Year : 1999 | Volume
: 47 | Issue : 1 | Page : 36--37
An alternative approach to a posteriorly dislocated intraocular lens
JL Aggarwal, HS Ahluwalia
Huddersfield Royal infirmany, Lindley, Huddersfield, United Kingdom
J L Aggarwal
Huddersfield Royal Infirmary, Lindley, Huddersfield HD3 3EA, West Yorkshire
|How to cite this article:|
Aggarwal J L, Ahluwalia H S. An alternative approach to a posteriorly dislocated intraocular lens.Indian J Ophthalmol 1999;47:36-37
|How to cite this URL:|
Aggarwal J L, Ahluwalia H S. An alternative approach to a posteriorly dislocated intraocular lens. Indian J Ophthalmol [serial online] 1999 [cited 2022 Nov 27 ];47:36-37
Available from: https://www.ijo.in/text.asp?1999/47/1/36/22806
Posterior dislocation of an intraocular lens (IOL) is a recognised complication of posterior chamber IOL implantation. The most common cause of this unfortunate event is a rupture of the posterior capsule or an implant of inappropriate size.
A 78-year-old Caucasian female was admitted for a left extracapsular cataract extraction (ECCE) with a posterior chamber intraocular lens (PCIOL) implantation on 16 June 1993 at Huddersfield Royal Infirmary. Her right eye was pseudophakic with a best corrected visual acuity of 6/6. The left eye had a best corrected preoperative visual acuity of 6/24. She underwent a left ECCE with a PCIOL under general anaesthesia. Surgery was complicated by a rupture of the posterior lens capsule but there was no vitreous prolapse or loss. A 22 D PCIOL, 14mm long, 6mm optic PMMA, was placed in the iridociliary sulcus. A peripheral iridectomy was also performed.
On the first postoperative day the cornea was clear and the anterior chamber was deep, with some lens matter in the pupillary area but the IOL was missing from the pupillary plane. The IOL was discovered on examination of the posterior segment under mydriasis, lying in the retinal periphery at 6 o'clock position. The IOL did not move with eye movements. There was no evidence of any retinal pathology including haemorrhage or breaks, and the posterior vitreous face was attached. The vitreous was clear and there was no herniation of vitreous into the anterior chamber.
Four days after the initial intervention a 19 D secondary anterior chamber intraocular lens (ACIOL) (Figure) was implanted without disturbing the original implant which remained in the posterior segment. Another iridectomy was performed to avoid pupillary block glaucoma. Postoperatively the course was uneventful with no undue inflammation. Three days postoperatively she had an intraocular pressure of 29 mmHg which settled with 0.25% timolol and acetazolamide 250 mg once a day.
Acetazolamide was discontinued a week later. The sutures were removed from the left eye 8 weeks postoperatively and her best corrected visual acuity was 6/9 in the left eye. The timolol 0.25% eye drops were changed to betaxolol 0.5% due to poor tolerance. The dislocated lens implant remains in the retinal periphery with no apparent damage to the retina and the patient still enjoys a left visual acuity of 6/9.
Various management techniques for a posteriorly dislocated IOL have been described, most of them involve vitrectomy and removal or repositioning of the implant. Balent et al described prophylactic retinal photocoagulation with secondary ACIOL implantation in one case. Jacobi et al have also reported one case of posterior dislocation of a Binkhorst loop iris-supported IOL which was replaced by an ACIOL leaving the dislocated IOL in situ. Smiddy et al4 have reported a series of 78 eyes with dislocated IOLs, but in all cases the IOLs were removed.
The ultimate prophylaxis of all the problems arising from lens dislocation is its removal or repositioning. Our suggestion of leaving the dislocated lens implant in situ and performing a secondary ACIOL implantation, though not without risk, provides good visual rehabilitation and is in our opinion a useful alternative in selected cases where a major surgical procedure is not desirable. It is nearly 4 years since the secondary anterior chamber IOL was implanted and the patients eye has remained stable. Her intraocular pressure remains under control with betaxolol 0.5% eye drops.
|1||Aplar JJ, Fechner P. Fechner's Intraocular Lenses. 1986. p 328.|
|2||Balent A, Civerchia L, Mohamadi P Lauderdale F. The double implant: alternative management for intraocular lens dislocation. J Cat and RefSur 1986;12:79.|
|3||Jacobi KW, Krey H, Giesen. American Intraocular Implant Society Journal 1983;9:58-59.|
|4||Smiddy WE, Ibanez GV, Alfonso E, Flynn HW. J Cat and Ref Sur 1995;21:64-69.|