Acute Ocular Hypertension Revealing A Late Spontaneous Posterior Capsule Rupture With A Dislocation Of An Intra-Ocular Lens: A Case Report

To report a case of an intra-ocular lens dislocation due to late spontaneous rupture of the posterior capsule in a patient with a history of refractive surgery.

Military Hospital of Tunis, Tunisia

A 53-year-old man presented in our emergency department for a painful red right eye (RE) since 4 hours. History taking revealed a cataract surgery ten years ago and previous keratorefractive surgery for high myopia in both eyes. Best corrected visual acuity was counting fingers in right eye and 20/200 in the left eye. Slit lamp examination of the RE revealed epithelial corneal edema, an intra-ocular pressure of 50 mmHg and a ruptured posterior capsule without visible intraocular lens (IOL). Fundus examination was impossible. Ultrasound B Scan objectified a dislocated IOL with vitreous reaction. No ocular trauma has been reported by the patient. Examination of the left eye showed a nuclear cataract and a high myopia fundus characteristics. The patient underwent second cataract surgery after lowering the IOP with intravenous mannitol 20%  and topical drops. Haigis formulae was used to determine the IOL power of the RE.  Surgical management was challenging with an anterior dragging of the dislocated IOL and a successful implantation of three pieces IOL in the sulcus.  

Spontaneous rupture of the posterior capsule is a rare post-operative complication and has not been frequently reported in the literature.  In this case, high myopia could be the predisposing factor. The suitable formulae to choose in patients with a history of refractive surgery  and surgical management to resolve the aphakia are challenging.