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A 27-year-old man with traumatic partial dislocation of an intraocular lens
Digital Journal of Ophthalmology 2016
Volume 22, Number 1
February 2, 2016
DOI: 10.5693/djo.03.2015.10.003
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Cory Miller, BS | University of Minnesota Medical School, Minneapolis Luke Dolezal, BA | University of Minnesota Medical School, Minneapolis Sandra R. Montezuma, MD | Department of Ophthalmology & Visual Neurosciences. University of Minnesota, Minneapolis
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| Diagnosis and Discussion | Pupillary capture of posterior chamber IOLs used to be common, with an incidence as high as 3% in the 1970s. It has since declined to between 0.6%-2.6% due to better IOL design and in-the-bag implantation.(1) However, several cases of pupillary capture after in-the-bag implantation of foldable silicone or soft acrylic IOLs have been reported, highlighting the ongoing importance of this complication.(2-4) Options for management of anterior dislocation of a posterior chamber IOL include no intervention, mydriasis with external manipulation and subsequent pharmacological myosis, direct surgical manipulation, and laser-induced mechanical shock-wave lens retropulsion.(5)
Galvis et al described a case of complete pupillary capture of an IOL after routine dilation with uncomplicated extracapsular cataract extraction 6 years previously.(6) After unsuccessful relocation with simple dilation, the IOL was successfully relocated with complete dilation and lens manipulation by applying corneal pressure with a three mirror lens and subsequent pupil constriction. Bowman et al reported a patient presenting with blurry vision and partial pupillary capture of an inferior optic that repositioned into the plane of the ciliary sulcus after gentle digital percussion on the temporal side of the patient’s closed lid.(7)
Other cases of surgical treatment for anterior dislocation of the IOL have been reported with an unremarkable recovery.(8) Superstein and Gans reported a case of traumatic anterior dislocation of a posterior chamber IOL in an 85-year-old man leading to reduction of visual acuity to hand motions and hyphema.(9) The dislocated IOL was exchanged for an anterior chamber IOL, with improvement of visual acuity to 20/40.
Nd:YAG laser photodisruption has also been described as a method for IOL relocation. For optics that are sufficiently mobile, the pressure wave created by the laser shifts the IOL back into position. Steinert and Puliafito reported a case of a posterior chamber IOL that dislocated anteriorly with routine pupillary dilation.(10) Redilation and mechanical manipulation were unsuccessful at relocating the optic. A 6 mJ pulse from an Nd:YAG laser applied to the peripheral edge of the IOL created pressure anteriorly that pushed the optic posteriorly behind the pupillary sphincter. Bartholomew reported 8 successful relocations of posterior chamber IOLs using Nd:YAG in 12 attempted treatments.(11)
In the present case a traumatic partial dislocation of a posterior chamber IOL with pupillary capture was successfully relocated with simple dilation and supine positioning. We recommend attempting this approach first in uncomplicated cases to avoid surgical, laser, or external lens manipulation treatment. If this technique is unsuccessful, pupil dilation with external manipulation may be indicated. If external manipulation fails, laser or surgical therapy can be considered.
Financial support
University of Minnesota, Minneapolis, Minnesota; Research to Prevent Blindness (RPB), New York, NY. | |
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