Traumatic fracture of flexible anterior chamber intraocular lenses

Fracture of a polyimide-elastimide posterior chamber intraocular lens following blunt orbital trauma

PURPOSE

Fracture of a three-piece polyimide-elastimide intraocular lens at the optic-haptic junction following blunt trauma is a possible complication after cataract surgery. We report a case of an isolated posterior chamber intraocular lens fracture caused by direct ocular blunt trauma.

CASE

A 51-year-old patient underwent blunt orbital trauma caused by a raw chicken egg that was thrown at him, as he was walking. The posterior chamber intraocular lens was found in the anterior chamber, with a broken optic-haptic junction. The intraocular lens was exchanged, followed by iris fixation and pupilloplasty, with satisfactory postoperative anatomical and optical outcomes.

DISCUSSION

The three-piece polyimide-elastimide intraocular lens was fractured at the optic-haptic junction. Although the fractured intraocular lens surface had a regular appearance, it has been previously reported that the polyimide haptic's durability is probably inferior to that of polymethylmethacrylate. Therefore, it is highly susceptible to shear stress induced by a blunt trauma.

CONCLUSION

To our knowledge, this is an uncommon report of an implanted posterior chamber polyimide-elastimide intraocular lens fracture following blunt orbital trauma. Intraocular lens exchange and fixation had successful optical and anatomical results.

Spontaneous Fracture of an Implanted Posterior Chamber Intraocular Lens

Purpose

Spontaneous fracture of an intraocular lens (IOL) haptic is a rare complication of cataract surgery. The authors report a case of spontaneous fracture of an implanted posterior chamber IOL.

Case

Five years ago, a 12-year-old patient underwent linear lens extraction, posterior capsulotomy, and anterior vitrectomy due to traumatic cataract and received a polymethyl methacrylate (PMMA) biconvex posterior chamber IOL implanted in ciliary sulcus. Five years later, IOL optic was found in anterior chamber with its haptics broken from the optic-haptic junction.

Discussion

The broken haptic was examined with scanning electron microscopy. The fracture site of the haptic was on the optic-haptic junction. The fractured surface had a regular appearance.

Conclusions

To our knowledge, this is the fourth report of spontaneous fracture of an implanted posterior chamber IOL.

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.

Prospective evaluation of intraoperative intraocular lens stress fracture during cataract surgery

PURPOSE

To determine the incidence and risk factors of intraocular lens (IOL) stress fracture during cataract surgery.

SETTING

Ivey Eye Institute, London, Ontario, Canada.

DESIGN

Prospective, randomized cohort study.

METHODS

Patients scheduled for routine cataract surgery were randomized into 2 study groups. The 2 groups only differed in the use of Monarch IOL delivery cartridges for insertion of an Acrysof IQ SN60WF IOL. The cartridge C group used Monarch cartridge C, and the cartridge D group used Monarch cartridge D. Patients were examined for IOL stress fractures.

RESULTS

A total of 386 study eyes were enrolled. The overall incidence of IOL stress fracture was 6.22%. The incidence of IOL stress fracture with cartridge C and cartridge D groups were 3.16% and 9.18%, respectively (P = .01). The IOL stress fracture rate for IOL power less than 18.0 D was 3.45%, IOL power between 18.0 D to 23.5 D was 6.49%, and IOL power over 23.5 D was 10.81%. A total of 24 IOL stress fractures were observed. Among IOL stress fractures, 45.8% were equal to or less than 1.0 mm in length. Two thirds of stress fractures were located over the central 4 mm of the IOL optic. No subjective adverse visual outcomes were reported from any of the observed IOL stress fractures.

CONCLUSION

Intraocular lens stress fracture is recognizable risk during cataract surgery. Risk factors for IOL stress fracture include smaller IOL delivery cartridges and IOLs of higher refractive powers. There was a low risk for IOL stress fracture resulting in adverse subjective visual outcomes.

Traumatic fracture of posterior chamber intraocular lens

An 18-year-old man developed a fracture in a single-piece polymethylmethacrylate posterior chamber (PC) intraocular lens (IOL) at the optic-haptic junction with dislocation of the IOL into the anterior chamber after a fist injury to the eye. The dislocated IOL was explanted and replaced with another PC IOL.

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.