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Unusual solutions for unusual cases

Poster Details

First Author: S.Barros PORTUGAL

Co Author(s):    J. Cardoso   A. Miranda   N. Marques   F. Fraga   A. Pereira   N. Campos     

Abstract Details

Purpose:

Intraocular lens (IOL) subluxation is a serious complication of cataract surgery. Bag dislocation may occur as a result of progressive zonular dehiscence many years after surgery. Capsular tension ring (CTR) implantation provides a reasonable preventive measure from the complication of in-the-bag IOL dislocation by supporting the zonules after cataract surgery, however, late spontaneous IOL and CTR dislocation within the capsular bag is reported. . It can cause decrease visual acuity, diplopia and pain or discomfort in cases where part of the CTR or IOL is rubbing against the iris or ciliary body and inflammation results.

Setting:

Ophthalmology Department, Garcia de Orta’s Hospital

Methods:

81 years-old man presented with 3 days decreased visual acuity in his right eye with moderate pain. He mentioned cataract surgery 15 years ago and subluxation of the IOL with subsequent replacement 1 year ago. On examination, best corrected visual acuity was hand movements in right eye and 2/10 in left eye. IOPs were 14/13 in right and left eye, respectively. In the right eye Fuchs dystrophy, Kruckenberg spindle and tyndall3+, without hipopion were evident. After dilation, an anteriorly displaced CTR was evident and fundoscopy showed vitritis4+. In the left eye, Fuchs dystrophy and extensive corioretinal athrophy were evident.

Results:

To exclude other causes, aqueous humor was collected to mycobacterial and PCR analysis. Intracamerular injection of cefuroxime was given and he was prescribed topical vigamox, dexamethasone and cycloplegic. Next day, significant improvement was observed: he had tyndall and vitritis grade 2+, apparently without retinal lesions, vasculitis nor choroiditis. Specular microscopy couldn’t count cells. Macular OCT showed mild macular applanation. Fluorescein angiography showed a mild hyperfluorescence perimacular point without dimension change over time. Aqueous humor analysis, immune and infectious peripheral blood analysis were negative. Treatment was mantained and oral corticosteroids were added but although vitritis had totally disappeared, tyndall 2+ remained unchanged for 2 months.

Conclusions:

This was interpreted as being a particular case of uveitis due to iris trauma caused by the subluxated capsular tension ring, which was also causing pigment dispersion due to iris rubbing, and inflammatory cells spillover to the vitreous. In an attempt to equalize pressures between chambers and eliminate CTR-iris contact, iridotomy was performed, avoiding a reintervention that could compromise his cornea. He has now one month follow-up and his best corrected visual acuity is 5/10, he has no inflammatory cells in the anterior chamber or vitreous and fundoscopy is unchanged.

Financial Disclosure:

NONE

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