Broken But Stable: In-The-Bag Implantation Of An Intra-Ocular Lens With A Fractured Haptic

To report a rare intraoperative complication of an intraocular lens (IOL) haptic fracture during phacoemulsification and to highlight the feasibility and stability of in-the-bag IOL implantation despite a fractured haptic.

Tertiary eye care center, Sindh Institute of Ophthalmology and Visual Sciences, SIOVS Hyderabad, Pakistan.

A patient undergoing routine phacoemulsification with posterior chamber IOL implantation developed an unexpected fracture of one haptic during lens delivery into the capsular bag. The fracture occurred near the haptic–optic junction, likely related to mechanical stress during injector-assisted implantation. After careful intraoperative assessment, the remaining haptic and optic were found to be well positioned within the capsular bag, with adequate centration and capsular support. Considering the stability of the lens–capsule complex and absence of zonular compromise, the decision was made to retain the IOL rather than explant and replace it. The lens remained centered with good capsular support at the end of surgery. Postoperatively, the patient achieved satisfactory visual recovery with stable IOL centration and no evidence of tilt, decentration, or capsular complications during follow-up.

A fractured IOL haptic does not always mandate immediate explantation. In carefully selected cases with intact capsular support and stable optic centration, in-the-bag retention of the IOL may be a safe and effective option. Careful intraoperative judgment and close postoperative monitoring are essential to ensure long-term stability and optimal visual outcomes.