Late Binocular In-The-Bag Intraocular Lens Dislocation: A Case Report

The case describes a rare incident. Most cases of Late IOL dislocation are associated with surgical trauma or zonulopathy. This patient presents IOL dislocation following contusion after explosion.

Department of Ophthalmology, Kharkiv National Medical University, Ophthalmic Diagnostics Center “ZIR”, Kharkiv, Ukraine

A 78-year-old male came to the clinic complaining of painless vision loss.In 2014 he underwent phacoemulsification of cataracts with intra-ocular lens IOL insertion binocularly at weekly intervals. It is noteworthy that the operative documentation stated that she had weak zonules in the left eye. In 2019 he underwent YAG capsulotomy binocularly. Since then he had good vision of 1,0 in both eyes with no further ocular problems until а rocket explosion near his house. On examination, IOLs were present in both eyes but displaced downward so that the superior edge was visible. Visual acuity was 0,7/0,3. UBM study showed partial ligament lysis with in-the-bag intraocular lens dislocation. The patient underwent surgical treatment: repositioning and suturing of the dislocated IOL in the left eye. After surgery, the IOL position was stable and visual acuity improved to 0.7. A similar operation is planned on the right eye.

Pseudoexfoliation is known to be associated with progressive zonulopathy, a degenerative process at the interface of the zonule to the basement membrane of the ciliary processes. The trauma-induced part destruction of  the zonular fibers and subsequent dislocation of the capsular bag IOL complex. The advantage of repositioning and suturing the dislocated IOL, rather than exchanging the lens, is reduced ocular and specifically endothelial trauma, and less postsurgical astigmatism due to a smaller incision