ESCRS - PO013 - Insertion Of A Posterior Chamber Lens Haptic Into A Fibrosed Posterior Capsular Tear To Achieve Enhanced Lens Stability And Centration.

Insertion Of A Posterior Chamber Lens Haptic Into A Fibrosed Posterior Capsular Tear To Achieve Enhanced Lens Stability And Centration.

Published 2025 - 43rd Congress of the ESCRS

Reference: PO013 | Type: Case Report | DOI: 10.82333/ze19-4a57

Authors: Disha Singhania* 1 , Tanvi Khetan 1 , Victoria Cosgrove 1 , Mukhtar Bizrah 1

1Western Eye Hospital,Imperial College Healthcare NHS Trust,London,United Kingdom

Purpose

The objective of this case report is to present a novel surgical technique for secondary intraocular lens (IOL) implantation, involving the insertion of a posterior chamber (PC) lens haptic into a fibrosed posterior capsular tear in the context of zonular weakness to achieve enhanced lens stability and centration. To date, no similar cases have been documented in the existing literature.

Setting

We report the case of a 55 year old female who was listed for left eye secondary lens insertion. She presented to cornea clinic at the end of 2022 with left eye bullous keratopathy on a background of corneal oedema due to anterior chamber (AC) IOL endothelial touch.

Report of case

This patient was a primary angle closure patient who had complicated cataract surgery in 2015 (PC rupture, zonular dialysis) and was left aphakic, with secondary AC IOL insertion in 2016. Her AC IOL was removed in January 2024 due to corneal endothelial touch, with a subsequent DSAEK in July. Her biometry showed an optical axial length of 16.38.
Intra-operatively, the capsule was found to be partially intact with an existing inferior PC hole with some fibrosis. The capsule had potential adequate support for a PC IOL. Alcon MA60AC of maximum power (+30D) was inserted into the posterior capsule, but superiorly decentred whilst the haptics were dialled 360 degrees in the bag due to zonular weakness at 11-2 clock hours. The inferior IOL haptic was partially cut using a lens cutter and removed, and the residual was inserted through the existing PC hole to secure the IOL. This left the IOL with good centration and minimal tilt.
Pre-operative visual acuity was OD 6/15 (gls) and OS 6/48 (UA). Intraocular pressure (IOP, iCare) was 15 mmHg OD and 19 mmHg OS. On D17 post-operatively visual acuity of OS was 6/30 (UA) and IOP was 11. The IOL is centred and stable in the PC, and the patient was very happy with the visual outcome. She is awaiting refractive correction.

Conclusion/Take home message

This case report presents the first documented instance of implanting a haptic within a fibrosed posterior capsular tear, resulting in enhanced stability and centration of the IOL. This approach also minimises the risk of endothelial touch compared to an AC IOL in a known small eye and provides the opportunity for subsequent insertion of an additional lens for refractive correction in this particular case. This technique may serve as a valuable option when managing challenging centration or stabilisation of a secondary IOL involving a fibrosed posterior capsular tear.