In-the-bag dislocation of polyfocal full-optics accommodativ
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A 56-year-old man was referred to our hospital with the chief complaint of sudden-onset visual disturbance in his left eye without trauma. He had undergone uneventful phacoemulsification with IOL implantation in the left eye at the local ophthalmic clinic 7 years prior. At that time, the preoperative uncorrected visual acuity (UCVA) at far distance was 20/60 (OS, oculus sinister) by Snellen chart and manifest refraction (MR) was not assessed due to crystalline lens opacity. Implantation of IOL was performed with 3-mm sized temporal clear corneal incision and without any intra-operative complication.

The postoperative UCVA at far distance was 20/20 (OS), and remained stable until the event of a sudden visual loss. At the time of current admission, the UCVA at far distance was 20/20 (OD, oculus dexter) and 20/1000 (OS, read 20/200 at 1-meter distance) by Snellen chart, and intraocular pressure (IOP) by applanation tonometry was 20 mmHg (OD) and 27 mmHg (OS). He had a MR of + 16.25 diopter (D) Sph/-1.00 D Cyl × 95 (OS), and corrected vision was 20/200 (OS). Axial length was 21.78 mm (OD) and 21.77 mm (OS). In the left eye, neither the lens capsule nor the IOL were visible via front-view slit lamp examination, and a IOL-capsular bag complex was dislocated into posterior vitreous in a fundus examination.

The right eye yielded no abnormal findings. The patient underwent 25-gauge pars plana vitrectomy and removal of the dislocated IOL-capsular bag complex through 8-mm sized superior scleral tunnel incision. Scleral fixation of a foldable acrylic single-piece IOL (Rayner Superflex 620H; Rayner Intraocular Lenses Limited, Hove, East Sussex, UK), was performed using the ab-externo technique at the 2 o' clock and 8 o' clock positions, and the scleral incision site was sutured using 10-0 nylon. At the time of surgery, the dislocated IOL-capsular bag complex did not exhibit severe anterior capsular contraction or IOL surface modification. One week later, the UCVA was 20/20 (OS) with a MR of +0.75 D Sph/-1.00 D Cyl × 84, and IOP was 18 mmHg.

Source: Indian Journal of Ophthalmology

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