Year : 2003 | Volume
: 51 | Issue : 2 | Page : 177--178
Anil K Mandal, R Anand
VST Centre for Glaucoma Care, L V Prasad Eye Institute, Banjara Hills, Hyderabad, India
Anil K Mandal
VST Centre for Glaucoma Care, L V Prasad Eye Institute, Banjara Hills, Hyderabad
Post-traumatic subconjunctival dislocation of an intraocular lens (pseudophacocele) is a rare but serious complication following cataract surgery. All the previously reported cases were managed by removal of the IOL rendering the eye aphakic. We report a case of traumatic pseudophacocele which was successfully managed by an IOL exchange.
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Mandal AK, Anand R. Traumatic pseudophacocele. Indian J Ophthalmol 2003;51:177-178
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Mandal AK, Anand R. Traumatic pseudophacocele. Indian J Ophthalmol [serial online] 2003 [cited 2022 Oct 7 ];51:177-178
Available from: https://www.ijo.in/text.asp?2003/51/2/177/14709
Subconjunctival dislocation of intraocular lens implant, termed pseudophacocele, is a rare complication following cataract surgery. It usually occurs after blunt trauma. We report a case of traumatic pseudophacocele which was successfully managed by removal of subconjunctivally dislocated Posterior chamber intraocular lens (PC IOL) with anterior vitrectomy and placement of a new PC IOL in the ciliary sulcus anterior to the peripheral capsular rim.
A 55-year-old woman had undergone an uneventful extracapsular cataract extraction with implantation of posterior chamber intraocular lens (PC IOL) in her left eye. About 3 weeks postoperatively, she sustained blunt trauma, with sudden diminution of vision in the operated eye. On examination, best corrected visual acuity in the left eye was 6/60. The eye was photophobic but there was no eyelid tenderness or swelling. There was hypotony but the anterior chamber was well-formed and had 2+ cells and flare. The pupil was dilated, fixed and peaked at the 1 o' clock position. The eye was aphakic and there was rupture of the posterior capsule superiorly with the rim of the posterior capsule visible inferiorly. A PC IOL with polypropylene haptics was seen in the superonasal subconjunctival perilimbal area without any evidence of conjunctival wound dehiscence [Figure 1]. Fundus examination revealed mild vitritis in the affected eye.
At surgery, the subconjunctivally dislocated PC IOL was removed easily through a conjunctival peritomy incision where fibrosis was noted around the polypro-pylene haptic. No fibrosis had occurred elsewhere. There was dehiscence of the corneoscleral wound with broken interrupted monofilament nylon sutures, and vitreous and iris were incarcerated in the wound. A meticulous anterior vitrectomy by the closed chamber technique removed all the vitreous from the wound and the anterior chamber. Following this, the iris was released from the wound to make the pupil central and circular. The end-point of vitrectomy was a concave iris surface with central, circular pupil indicating absence of vitreous in the anterior chamber. A peripheral iridectomy was seen that had been performed during the original surgery. A PC IOL was placed in the ciliary sulcus with inferior capsular rim as a support [Figure 2]. An overall diameter of 13.5 mm with 6.5mm optic size all-PMMA lens was selected for exchange and the IOL power calculation was based on the fellow eye. The corneoscleral wound was closed with interrupted 10-0 nylon sutures and the conjunctiva was repositioned over the wound. On the first postoperative day, the anterior segment appeared satisfactory. Six weeks later, the patient's best-corrected visual acuity was 6/12. The anterior chamber remained deep and quiet, and there was no vitreous incarceration in the wound.
Subconjunctival extrusion of the IOL following blunt trauma has been reported previously. Biedner et al first reported a case of subconjunctival dislocation of an IOL implant and termed it pseudophacocele. The implant was a Binkhorst iris clip lens fixed after uncomplicated intracapsular cataract surgery. Subsequently, Bene and Kranias and Sandramouli et al reported dislocation of PC IOL into the subconjunctival space following blunt trauma. Foster et al  described a PC IOL that had dislocated into the suprachoroidal space. In extreme cases, the PC IOL may be completely extruded from the eye. In the present case, blunt trauma had caused subconjunctival extrusion of the PC IOL producing pseudophacocele with dehiscence of the corneoscleral wound and hypotony without any disruption of the limbal conjunctival attachment. This could be explained by the higher conjunctival elasticity compared to the sutured corneoscleral wound.
In all the previously reported cases,,, which were managed by removal of the subconjunctivally dislocated PC IOL with or without trans pars plana vitrectomy, the eye was rendered aphakic. In the present case we could implant a PC IOL in the ciliary sulcus anterior to the capsular rim after removal of the subconjunctivally dislocated PC IOL. An adequate anterior vitrectomy and release of incarcerated iris from the wound enabled us to obtain a central and circular pupil. The patient's pseudophakic visual acuity returned to normal level. To the best of our knowledge this is the first reported case of a subconjunctivally dislocated PC IOL managed successfully without creating aphakia.
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