Broken semiflexible intraocular lens implant

Fracture and dislocation of a glass intraocular lens optic as a complication of neodymium:YAG laser posterior capsulotomy: Case report and literature review

An 83-year-old man presented with a 1-year history of blurry vision in his left eye. Bilateral cataract surgery and ciliary sulcus posterior chamber intraocular lens (IOL) implantation had been performed 11 years earlier. The corrected distance visual acuity (CDVA) was 20/60 in the left eye. Slitlamp examination revealed moderate posterior capsule opacification. Neodymium:YAG laser posterior capsulotomy was performed and complicated by IOL fracture and immediate dislocation of optic fragments into the anterior chamber. An IOL exchange was performed, and the damaged IOL was removed in 7 pieces. A 3-piece acrylic IOL was suture fixated to the posterior iris. Pathologic analysis showed that the damaged IOL was made of glass supported by a polyimide frame. Twelve months after the IOL exchange, the CDVA was 20/60.

FINANCIAL DISCLOSURE

Dr. Ahmed is a consultant to Alcon Laboratories, Inc., Abbott Medical Optics, Inc., and Bausch & Lomb. Dr. Mamalis is a consultant to Anew Optics, Inc., and Medennium, Inc. No other author has a financial or proprietary interest in any material or method mentioned.

Retained IOL fragment and corneal decompensation after pseudophakic IOL exchange

A 72-year-old man had exchange of a foldable silicone multifocal intraocular lens (IOL) by transection, removal, and monofocal IOL replacement. One month after the exchange, irreversible corneal edema developed and penetrating keratoplasty was performed. At the time of the corneal transplant, a small silicone fragment was discovered in and removed from the anterior chamber. Histologic evaluation of the patient's cornea demonstrated an absence of corneal endothelium, suggesting the fragment was the etiology of the corneal decompensation.

Spontaneous disinsertion of a haptic from a 3-piece acrylic foldable intraocular lens after surgery

A 49-year-old man with cataracts had uneventful phacoemulsification, continuous curvilinear capsulorhexis, and implantation of an MA30BA acrylic foldable intraocular lens (IOL) in the bag. One week later, 1 haptic spontaneously dropped off and the optic dislocated into the anterior chamber. The IOL was surgically removed and replaced with a new acrylic foldable IOL. Examination of the explanted IOL revealed that the loop hole was not created in the middle of the side face, leading to in vivo detachment of the haptic postoperatively.

Corneal decompensation and graft failure secondary to a broken posterior chamber poly(methyl methacrylate) intraocular lens haptic

A 66-year-old man developed an unexplained corneal decompensation 7 years after extracapsular cataract extraction and implantation of a single-piece poly(methyl methacrylate) (PMMA) posterior chamber intraocular lens (IOL). He had penetrating keratoplasty (PKP). Two years later, he developed corneal graft failure secondary to an IOL haptic fragment in the anterior chamber angle. The patient had a repeat corneal graft and IOL exchange. The broken haptic was examined with scanning electron microscopy. The findings were consistent with late fracture of the haptic within the capsular bag, which was presumably weakened by an improper implantation technique. Fracture of a PMMA haptic should be suspected as a cause of corneal decompensation and corneal graft failure after cataract surgery. This case emphasizes the importance of safe implantation techniques.

Traumatic fracture of flexible anterior chamber intraocular lenses

Two patients had fracture of a flexible, open-loop, anterior chamber intraocular lens (IOL) caused by ocular trauma. Case 1 was a 78-year-old woman with a three-point-fixation IOL. The two portions of the fractured lens were removed from the anterior chamber. Visual acuity at 10 months postoperatively was hand motion as a result of corneal decompensation. Case 2 was a 36-year-old man with a four-point-fixation IOL that broke and dislocated into the vitreous. A pars plana vitrectomy was performed; the two lens portions were removed and exchanged with a sutured posterior chamber lens. Best corrected visual acuity 4 months postoperatively was 20/20. In both cases, the lens fracture took place at the loop-optic junction and with minimal visible damage to the eye structures.

Cracked acrylic intraocular lens requiring explantation

BACKGROUND

Intraoperative cracking of foldable acrylic posterior chamber intraocular lenses has previously been documented. However, most cracks have resulted in no significant visual impairment.

METHODS

A case report of an acrylic posterior chamber intraocular lens that cracked during folding.

RESULTS

The crack in the lens resulted in significant optical disturbance and required explanation and insertion of another lens.

CONCLUSIONS

Acrylic intraocular lenses must be folded carefully with appropriate forceps to prevent cracking of the optic.

In vivo fracture of an extruded polymethylmethacrylate intraocular lens loop

The inferior loop of a semiflexible, closed-loop anterior chamber intraocular lens in the eye of a 72-year-old female fractured at two sites. The loop was composed of extruded polymethylmethacrylate. The inferotemporal portion of the loop was first noted to be broken 25 months postoperatively, and the fractured nasal portion of the same loop was first observed 55 months after implantation. The patient denied any excessive rubbing of the eye or major trauma to the eye or head. Both fractures occurred near the loop-optic junction. The intermittent touch of the cornea by the broken loop caused endothelial damage and edema in the lower one third of the cornea. The two portions of the lens were removed and exchanged with another style of anterior chamber lens. The visual acuity at six weeks postexchange was 20/30.