Trust But Verify: Missed Partial Haptic Unfolding Of Single Piece Intraocular Lens Causing Persistent Cystoid Macular Edema
Published 2026 - 44th Congress of the ESCRS
Reference: POCAT096 | Type: Case Report | DOI: 10.82333/sn4q-0822
Authors: Dr Tamilarasi S* 1 , Dr Thenarasun SA 2
1Cataract,The Eye Foundation,Coimbatore,India, 2Retina,The Eye Foundation,Coimbatore,India
Purpose
To report a case of chronic postoperative inflammation and cystoid macular edema (CME) secondary to partial haptic unfolding of a single-piece intraocular lens (IOL), discuss potential intraoperative mechanisms, and emphasize the importance of verifying in-the-bag IOL positioning at the end of phacoemulsification.
Setting
The Eye Foundation, Coimbatore, a tertiary eye care center in Southern India.
Report of case
A 54-year-old male presented 9 months after cataract surgery in the right eye done elsewhere with persistent blurred vision. Despite repeated course of tapering topical steroids, BCVA remained 6/60. Slit-lamp examination revealed low-grade anterior chamber inflammation, pigments on a single-piece acrylic IOL, and a partially unfolded superotemporal haptic lying in the sulcus, with fused anterior and posterior capsules at that site. Macular OCT confirmed CME.
Likely contributing factors for slow or partial haptic unfolding include improper IOL loading, zonular weakness, inadequate capsular bag expansion, and unstable anterior chamber during implantation, particularly with hydro implantation techniques. Chronic mechanical irritation from the malpositioned haptic caused pigment dispersion and persistent inflammation.
Because the anterior and posterior capsules had fused, IOL exchange with intravitreal dexamethasone implant (Ozurdex) was advised. If identified early, simple repositioning of the partially unfolded haptic into the capsular bag could have reduced inflammation and avoided IOL exchange. The patient was subsequently lost to follow-up.
Conclusion/Take home message
Partial haptic unfolding of single-piece IOLs may go unrecognized intraoperatively, leading to chronic inflammation, pigment dispersion, and CME. Early identification, proper evaluation, and timely intervention are critical. Surgeons should verify complete in-the-bag haptic unfolding, particularly when using hydroimplantation, to prevent avoidable long-term complications.