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

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.

Corneal edema after phacoemulsification

Phacoemulsification is the most commonly performed cataract surgery in this era. With all the recent advances in investigations and management of cataract through phacoemulsification, most of the patients are able to achieve excellent visual outcome. Corneal edema after phacoemulsification in the immediate postoperative period often leads to patient dissatisfaction and worsening of outcome. Delayed onset corneal edema often warrants endothelial keratoplasty. This review highlights the etiopathogenesis, risk factors, and management of corneal edema in the acute phase including descemet's membrane detachment (DMD) and toxic anterior segment syndrome. Various investigative modalities such as pachymetry, specular microscopy, anterior segment optical coherence tomography, and confocal microscopy have been discussed briefly.

Delayed presentation of retained acrylic intraocular lens (IOL) fragment after uncomplicated cataract surgery

PURPOSE

To report a case of delayed presentation of a severed acrylic single-piece intraocular lens (IOL) haptic fragment causing corneal edema after uneventful phacoemulsification surgery.

OBSERVATIONS

An 85-year-old male presented with inferior corneal decompensation six months after a reportedly uneventful phacoemulsification in his left eye. A distal haptic fragment of an acrylic single-piece posterior chamber intraocular lens was found in the inferior anterior chamber angle. Intraoperative examination revealed that the dislocated fragment originated from the temporal haptic, the remainder of which was adherent to the anterior surface of the capsular bag. The clipped edge of the haptic fragment showed a clean, flat surface, suggesting it was severed by a sharp object. The findings were considered consistent with cutting of the fragment during implantation presumably from improper lens loading, improper implantation technique, or defective implantation devices.

CONCLUSIONS AND IMPORTANCE

This is the first case report of a foldable acrylic intraocular lens severed during routine uncomplicated cataract surgery that was not noted at the time of the surgery or in the immediate postoperative period. Delayed presentation of severed IOL fragments should be considered in cases of late onset corneal edema post-operatively, when other causes have been ruled out. Careful implantation technique and thorough examination of the intraocular lens after implantation to assess for lens damage intraoperatively is essential to avoid such rare complications.

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.

A Surprising Cause for Corneal Edema after Cataract Surgery: A Missed Posterior Chamber Intraocular Lens Haptic Remnant

We present a case of retained intraocular lens (IOL) haptic segment in the anterior chamber, diagnosed seven months following a reportedly uneventful cataract surgery due to manifestation of inferior corneal edema. Specular microscopy revealed low endothelial counts of 513/mm(2). Upon diagnosis, prompt surgical removal of the IOL haptic segment resulted in rapid resolution of the corneal edema within a week. Despite the clearing of the cornea, no improvement in the visual acuity occurred and cystoid macular edema was diagnosed and treated with topical anti-inflammatory agents and two intra-vitreal anti-VEGF injections, followed by complete resolution of ocular findings and improvement of the visual acuity.

Simultaneous corneal inlay implantation and laser in situ keratomileusis for presbyopia in patients with hyperopia, myopia, or emmetropia: six-month results

PURPOSE

To evaluate the safety and efficacy of simultaneous Kamra corneal inlay implantation and laser in situ keratomileusis (LASIK) for the treatment of presbyopia in emmetropic, hyperopic, or myopic patients.

SETTING

Private center, Tokyo, Japan.

DESIGN

Cohort study.

METHODS

Patients had bilateral LASIK with simultaneous implantation of a corneal inlay in the nondominant eye to treat presbyopia and ametropia between September 2009 and April 2010. The efficacy and safety were determined by the spherical equivalent (SE) in the eye with the inlay.

RESULTS

The study enrolled 360 eyes of 180 patients with a mean age of 52.4 years ± 5.1 (SD) (range 41 to 65 years). Sixty-four patients were available for the 6-month postoperative examination. The mean logMAR uncorrected near visual acuity in the eye with the inlay improved 7 lines in hyperopic eyes, 6 lines in emmetropic eyes, and 2 lines in myopic eyes. The mean logMAR uncorrected distance visual acuity improved by 3 lines, 1 line, and 10 lines, respectively.

CONCLUSIONS

Simultaneous intracorneal inlay implantation and LASIK to treat presbyopia with emmetropia, hyperopia, or myopia was clinically safe and effective, yielding improvement in distance and near visual acuity. Patients were satisfied with decreased dependence on reading glasses regardless of the preoperative SE range. However, postoperative symptoms, such as dry eyes, halo, glare, or night-vision disturbances, occurred occasionally.

FINANCIAL DISCLOSURE

Dr. Waring has a financial interest in and is world surgical monitor for Acufocus. No other author has a financial or proprietary interest in any material or method mentioned.

Late corneal edema due to retained foldable lens fragment

Late onset of corneal edema after cataract surgery is an unusual complication. We report a case of corneal edema presenting one month after cataract surgery. During implantation of the foldable lens, one haptic of the intraocular lens fractured at the optic haptic junction. This caused lens decentration, necessitating an intraocular lens exchange ten days later. The patient was recovering well but presented again two weeks later with a drop in vision due to corneal edema. A retained haptic of the intraocular lens was seen in the inferior anterior chamber angle. After surgical removal of the retained haptic the corneal edema fully resolved. Retained intraocular lens fragments can cause corneal endothelial damage, which may be reversible with an early diagnosis and intervention.

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.