Anterior Chamber Artificial Lens Dislocation With Corneal Perforation - Case Report

The use of rigid anterior chamber lenses for cataract surgery is currently an unusual solution due to the continuous improvement of surgical techniques (iris fixation, scleral fixation) and the introduction of new technological solutions in the shape and material of intraocular implants. Implantation of rigid anterior chamber lenses is not free from complications, which most often include: damage to endothelial cells, corneal edema, chronic inflammation and secondary glaucoma. Corneal perforation is rare and is usually the result of trauma.
The authors describe the case of a patient with a vertically implanted anterior chamber lens who suffered corneal perforation.

A 57-year-old man came to the local ophthalmology clinic for a routine check-up. The last time the eye examination took place was two years earlier. 

Retrospective case report of a 57-year-old man after an injury to the right eyeball. The patient's history included blunt trauma to the right eyeball approximately 20 years ago, complicated by retinal detachment and post-traumatic cataract, which were treated in Ukraine. We are presenting the results of optical coherence tomography of the anterior segment of the eye (AS-OCT), ultrasound (USG), ultrabiomicroscopic (UBM) and surgical procedures aimed at protecting the eye.

Ultrabiomicroscopy revealed forward displacement of the anterior chamber artificial lens with corneal perforation and direct contact of the proximal part of the haptics with the corneal endothelium. Ultrasound examination showed normal ocular wall thickness in the posterior pole and secondary flat retinal detachment in the inferior temporal quadrant. Perforation of the cornea in the superior temporal quadrant caused by everted haptics of the anterior chamber artificial lens. Due to corneal perforation, it was decided to surgically remove the everted distal and proximal parts of the haptics. During hospitalization, empirical antibiotic therapy and anti-inflammatory treatment, both local and general, were implemented.

Corneal perforation after implantation of artificial anterior chamber lenses is rare. Significant advances in the techniques and materials used for cataract surgery in recent decades have resulted in a reduction in the number of implantations of these lenses. Scleral or iris fixation is currently the method of choice performed in patients with intraoperatively damaged posterior lens bag and in aphakic patients, however, extensive surgical experience is required to apply these techniques. In other cases, artificial anterior chamber lens implantation is an acceptable alternative.