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Inverted piercing sign in retropupillary intraocular lens

Poster Details

First Author: SPAIN

Co Author(s):    L. Esquinas-Beas   A. Ortueta   B. Sarmiento   M. Malmierca   M. De-Una        

Abstract Details


Subluxation of the lens is a frequent ocular manifestation of Marfan syndrome. Its surgical treatment includes extraction of the subluxated lens and correction of the postoperative aphakia. The treatment possibilities are: anterior chamber intraocular lens (IOL), posterior chamber IOL with transscleral fixation and retropupillary IOL with posterior fixation to the iris. Our objective is to evaluate the most appropriate surgical treatment for aphakia correction after extraction of subluxated lens in a patient with Marfan syndrome and low endothelial cell count. In addition, we describe the finding of perforation of the iris by the lens haptic forming the “inverted piercing” sign.


12 de Octubre Universitary Hospital, Complutense University, Madrid, Spain.


18 year-old woman with Marfan syndrome presented with bilateral subluxated lenses. Due to the fact that she had a low endothelial cell count and the lack of appropriate capsular support, it was decided that the best treatment option was the implantation of retropupillary IOL with posterior fixation to the iris. Surgical extraction of the lens and implantation of retropupillary IOL was performed in both eyes. The technique consisted of an anterior luxation of the lens followed by intracapsular aspiration. No vitrectomy was needed as anterior hyaloid membrane was preserved. Through a temporal corneal approach, an aphakic retropupillary IOL was placed.


Throughout the 1 year follow up period the retropupillary intraocular lenses remained stable and well positioned and visual acuity improved significantly. In the slit lamp exam we observe an inferior perforation of the iris by the IOL haptic due to sliding of the inferior enclavation, that doesn’t bring about any complications.


Previous studies comparing anterior chamber, transscleral posterior chamber, and iris fixated posterior chamber IOLs for correction of aphakia revealed no differences in safety or efficacy. Retropupillary aphakic intraocular lenses with posterior iris fixation are a good treatment option for ectopia lentis due to Marfan syndrome, especially in cases with a low endothelial cell count. With this technique, it is possible to find the “inverted piercing” sign, a manifestation of the perforation of the iris by the IOL haptic, that doesn’t cause any complications.

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