Management Of Anterior Displacement Of The Intraocular Lens-Capsular-Bag Complex And Secondary Glaucoma

To describe a case of spontaneous anterior displacement of the IOL-capsular-bag complex, secondary glaucoma and its management

Tritya Eye Clinic, Surabaya, East Java, Indonesia

A 65-year-old man presented with complaints of pain and decreased visual acuity in his right eye for one month. The patient underwent cataract surgery with intraocular lens implantation approximately 14 years prior, but there is no documentation available regarding the procedure. The examination revealed that the visual acuity in the right eye was limited to hand movement, and the intraocular pressure measured 44 mmHg. The slit lamp examination of the right eye revealed ciliary injection, a hazy cornea, and a dislocated intraocular lens encased in a fibrotic capsular bag within the anterior chamber. The ultrasound B-scan test revealed normal results. Two surgical procedures were scheduled to address this problem. The first step was the explantation of the intraocular lens to create an aphakic state. His aphakic visual acuity was limited to finger counting, with best-corrected visual acuity at 6/24, and intraocular pressure was 45 mmHg on glaucoma treatment. The second step involved the implantation of the IOL with trabeculectomy. One day post-surgery, the visual acuity was measured at 1/60, with an intraocular pressure of 8 mmHg. Corneal edema was present, a bleb was well-formed, and the anterior chamber was deep. Two months post-surgery, his best-corrected visual acuity was 6/9, with an intraocular pressure of 15.5 mmHg. 

The occurrence of spontaneous anterior displacement of the IOL-capsular-bag complex accompanied by secondary glaucoma is a rare condition. Careful selection of optimal management is essential to effectively address this issue and achieve the best outcomes for visual acuity and intraocular pressure (IOP).