Hang In There: The Story Of An Intraocular Lens

Intraocular lens (IOL) dislocation, although uncommon, has an incidence of 0.2% to 3.0%. We describe an unusual case which presented with late inferior IOL decentration in the absence of a visible posterior capsular defect or zonular weakness.

IOL decentration is not an uncommon complication post cataract surgery, and is usually dealt with by an IOL explantation with a secondary IOL implantation, which predisposes to excessive intraocular manipulation. We aim to devise less manipulative measures to deal with the same.

Our patient 68y/M came for routine left eye cataract surgery (Vision 6/24 NS2-3 Grade with diabetes) which was uneventful with Phacoemulsification & in-the-bag foldable IOL implantation with 6/9 vision on Day 1. On Day 4 patient presented with corneal honeycomb dystrophy after being on topical Ripasudil postoperatively, which subsided within few days of stopping the drug. Up until two weeks postoperatively IOL was centred; patient had no complaints and vision was good. In the third week, patient presented with diplopia; On undilated slit lamp examination: IOL appeared decentred inferiorly with optic-haptic junction noted in visual axis. The pupil was poorly dilating upto around 5mm, which did not afford a satisfactory view of the IOL-bag complex. Superiorly, from 9 to 11 o’clock optic was in the bag, post-11 o’ clock, entire superior haptic with adjoining optic was in sulcus; with some amount of capsular fibrosis at 10 o’clock. An attempt was made to reposition IOL keeping in mind the due risks of possible zonular dehiscence and IOL-bag complex subluxation. Intraoperatively, no zonular dialysis or posterior capsular rent were noted. Successful in-the-bag repositioning of the IOL resulted in improvement of vision quality post-operatively.

Instead of approaching the case with the usual IOL exchange with iris-fixated or anterior chamber IOL or by fixating it to the sclera, a relatively non-invasive sutureless method of IOL re-centration was performed. This goes to show that if patient is symptomatic, an attempt of redialling can be made even three weeks postoperatively, as an alternative to prolonged revision surgeries with IOL explantation, and secondary IOL implantation.