Minimally Invasive Intraocular Lens Exchange And Corneal Endothelial Repair For Spontaneous Haptic Breakage In A Pediatric Patient

To report a rare complication of spontaneous intraocular lens (IOL) haptic breakage in a 5-year-old pseudophakic patient presenting with severe corneal edema and elevated intraocular pressure. This report emphasizes the efficacy of a minimally invasive intraocular IOL transection technique for IOL exchange, combined with corneal endothelial rehabilitation, to avoid endothelial keratoplasty and successfully manage late pediatric cataract surgery complications.

The study was conducted at the Department of Ophthalmology, Center for Congenital Lens Diseases, Xi'an No. 1 Hospital, The First Affiliated Hospital of Northwest University, Xi’an, Shaanxi Province, China. As a tertiary referral center, it specializes in complex pediatric cataract management and anterior segment reconstruction.

A 5-year-old female presented with left eye photophobia, tearing, and vision loss for one month. History included bilateral phacoemulsification with IOL implantation over two years ago, and right eye IOL repositioning due to dislocation one year ago. Examination of the left eye revealed severe corneal edema, a shallow anterior chamber, an unreactive 1.5 mm pupil, and elevated intraocular pressure (25 mmHg). Ultrasound biomicroscopy and intraoperative findings confirmed a dislocated IOL with a spontaneously broken haptic, iris anterior and posterior synechiae, and vitreous prolapse. To protect the compromised corneal endothelium, a minimally invasive surgical approach was utilized. Under a soft-shell ophthalmic viscosurgical device technique, the dislocated IOL was dissected from organized fibrotic tissue. The IOL optic was transected intraocularly using microscissors and extracted, along with the fractured haptic, through a 2.2 mm clear corneal incision without wound enlargement. Following anterior vitrectomy and a secondary separation of the fibrosed capsular bag, a replacement IOL was implanted into the bag. Blunt synechiolysis was performed for anterior synechiae. Postoperatively, topical corticosteroids and hyperosmolar agents reversed the corneal decompensation.

Spontaneous IOL haptic breakage is a severe complication in pediatric pseudophakia. This case prompts discussion on the long-term biomechanical stability of pediatric IOLs. IOL material, haptic design, morphology of the anterior and posterior capsular openings, and capsular bag stability all affect intraocular IOL stability. Current literature suggests polyimide haptics may risk embrittlement in long-term warm environments, whereas single-piece hydrophobic acrylic designs may offer different mechanical profiles, pending further large-sample studies. However, once such structural failure occurs, safely managing the dislocated IOL is a core clinical challenge after pediatric cataract surgery.