Novel Technique For Detection Of Dislocated Intra-Ocular Lenses Using Ultrasound Biomicroscopy

To propose a novel technique using Ultrasound Biomicroscopy (UBM) to detect malpositioned or dislocated intraocular lenses (IOL) causing complications such as uveitis-glaucoma-hyphaema syndrome or spike of intraocular pressue (IOP) due to secondary pigment dispertion.

Glaucoma outpatient service and visual function department at a tertiary referral ophthalmology centre.

The UBM probe of 50 MHz of Quantel ABSolu ultrasound platform was rotated 360 degrees on the surface of the cornea with the axis of the probe parallel to the sagittal axis of the eye (Y axis of Fick), under topical anasthesia. Images were recorded either as a continuous video or as still images taken every 5-10 degrees of rotation. Images were analyzed to detect the position of the haptic and the optic of the IOL relative to the anatomical structres of the eye (iris, capsule and ciliary body).

Two patients were examined with the method described above. The first patient presented with blurry vision due to spontaneous hyphaema and increased IOP. The second patient had a spike in IOP following an uneventful catarct surgery combined with iStent inject W (Glaukos, San Clemente, CA, United States). Both patients had a UBM examination using the conventional technique, which was unable to provide any additional information on the position of the IOL. Due to strong clinical suspicion, UBM examination was repeated with the technique described above. In the first patient, the IOL was found at the level of the sulcus and in the second patient, one of the haptics was found at the ciliary sulcus causing friction to the posterior iris surface.

This novel imaging technique utilizing UBM, was able to detect malpositioned or dislocated IOL, which was not recognized using the conventional imaging technique. The new method also helped the surgeon to plan the surgical approach to reposition the IOL and reverse the deleterious effect.