Ophthalmic Surgery, Lasers and Imaging Retina

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Case Report 

Replacement of the Lens and its Capsule that Dislocated to the Anterior Chamber by the Posterior Iris Claw Lens

Mehmet Baykara, MD; Özgür Yalçinbayir, MD; Hikmet Özçetin, MD

Abstract

In a case with retinitis pigmentosa, the intraocular lens that dislocated to the anterior chamber 20 tears after the cataract surgery has been removed via scleral tunnel incision. Then, the iris claw lens was placed behind the iris again by the scleral tunnel. This case was reported as an example for both its existing and rehabilitation method.

Abstract

In a case with retinitis pigmentosa, the intraocular lens that dislocated to the anterior chamber 20 tears after the cataract surgery has been removed via scleral tunnel incision. Then, the iris claw lens was placed behind the iris again by the scleral tunnel. This case was reported as an example for both its existing and rehabilitation method.

Replacement of the Lens and its Capsule that Dislocated to the Anterior Chamber by the Posterior Iris Claw Lens

From the Department of Ophthalmology, Uludag University School of Medicine, Bursa, Turkey.

The authors have no financial or proprietary interest in the materials presented herein.

Address correspondence to Mehmet Baykara, MD, Uludag University Faculty of Medicine, Department of Ophthalmology, 16059, Gorukle, Bursa, Turkey.

Accepted: March 10, 2008
Posted Online: March 09, 2010

Introduction

As the capsular fibrosis is seen more often in cases with retinitis pigmentosa after lens surgery, lens dislocation may occur in the late periods. This causes decrement of the visual acuity that is already reduced due to the retinopaty.1,2 We wanted to report this case, which we removed the lens and its capsule through the scleral tunnel that was completely dislocated to the anterior chamber even with its capsule about 20 years after cataract surgery and replaced iris claw lens again through the scleral tunnel for treatment of aphakia.

Case Report

A 74-years-old man attended to our clinic with a complaint of decreased vision noticed 2 days ago. Twenty years ago, a cataract surgery has been performed to this patient with the implantation of a 17 D polymethylmethacrylate (PMMA) lens. He complained the decrement of visual acuity suddenly in 2 days. In early postoperative period visual acuity with best correction was 0.2 with logMAR. On his ophtalmological examination, visual acuity was 0.1 with logMAR, cornea was clear and intracular lens was dislocated completely to the anterior chamber with its capsule (Fig. 1) Intraocular pressure measured 16 mm Hg and fundoscopic examination showed pigmentary retinopaty. With an aim of using a surgical technique without suturing, dislocated lens and its capsule has been removed via scleral tunnel incision. Rigid iris claw lens implanted behind iris through scleral incision after anterior vitrectomy. Uncorrected visual acuity was 0.1 with logMAR at post-operative first day. Anterior segment examination was normal and the fundoscopic findings were the same. Follow-up examinations were performed on first day and first month, the last ophtalmological examination revealed a corrected visual acuity of 0.2 with logMAR, anterior segment examination was normal (Fig. 2) whereas fundus examination was also normal except pigmenter retinopathy findings. Intraocular pressure was 14 mm Hg. Iris angiography showed any leakage from the place that connected the lens clows to the iris (Fig. 3).

Dislocated IOL with Capsule.

Figure 1. Dislocated IOL with Capsule.

Postoperative Anterior Segment Photo.

Figure 2. Postoperative Anterior Segment Photo.

Iris Angiography (Vascular Phase, No Leakage)

Figure 3. Iris Angiography (Vascular Phase, No Leakage)

Discussion

Intaocular lens dislocation usually occurs when the zonules were weak as the result of exfoliation or trauma. Even it happens while using capsule tension ring.3–5 Capsular fibrosis usually causes late dislocations also it causes dislocation in pigmenter retinopaty.3,6 On these cases, replacement of the dislocated lens with a new one can be preferred as a surgical technique. Scleral tunnel is one of the ways of replacement of dislocated lens and implantation of the new lens. Scleral tunnel is preferred as its incision area can be self-sealing. In the cases without capsular support, implantation of the lens to the posterior chamber via scleral suturing or placement with its claw to the posterior iris may be preferred.8–10 Both replacement of the dislocated lens and implantation of the new lens have been performed safely without suturing by this technique.

References

  1. Hayashi K, Hayasahi H, Matsuo K, Nakao F, Hayashi F. Anterior capsule contraction and intraocular lens dislocation after implant surgery in eyes with retinitis pigmentosa. Ophthalmology. 1998Jul;105(7):1239–1243. doi:10.1016/S0161-6420(98)97028-2 [CrossRef]
  2. Lee H, Min SH, Kim TY. Bilateral spontaneous dislocation of intraocular lenses within the capsular bag in a retinitis pigmentosa patient. Korean J Ophthalmology. 2004Jun;18(1):52–57.
  3. Scherer M, Bertelmann E, Reick P. Late spontaneous in-the-bag intraocular lens and capsular tension ring dislocation in pseudoexfoliation syndrome. J Cataract Refractive Surgery. 2006April;32:672–675. doi:10.1016/j.jcrs.2006.01.041 [CrossRef]
  4. Masket S, Osher R. Late complications with intraocular lens dislocation after capsulorhexis in pseudoexfoliation syndrome. J Cataract Refractive Surgery. 2002;28:1481–1484. doi:10.1016/S0886-3350(01)01267-6 [CrossRef]
  5. Moreno-Montañés J, Heras J, Fernández-Hortalano A. Surgical treatment of a dislocated lens-capsular bag-capsular tension ring complex. J Cataract Refractive Surgery. 2005;31:270–273. doi:10.1016/j.jcrs.2004.04.041 [CrossRef]
  6. Davison JA. Capsule contraction syndrome. J Cataract Refractive Surgery. 1993;19:582–589.
  7. Blumenthal. Manuel ECCE, the present state of the art. Klin Monatsbl Augenheilkd. 1994Nov;205(5):266–270. doi:10.1055/s-2008-1045526 [CrossRef]
  8. Baykara M. Suture burial technique in scleral fixation. J Cataract Refract Surg. 2004May;30(5):957–959. doi:10.1016/j.jcrs.2003.09.048 [CrossRef]
  9. Mohr A, Hengerer F, Eckardt C. Retropupillary fixation of the iris claw lens in aphakia. One year outcome of a new implantation techniques. Ophthalmologe. 2002Jul;99(7):580–583. doi:10.1007/s00347-001-0563-z [CrossRef]
  10. Baykara M, Özçetin H, Avci R. Secondary posterior iris fixated aphakic lens implantation by scleral tunnel incision. XXIV. ESCRS Congress. 2006 London. Abstract Book 19.
Authors

From the Department of Ophthalmology, Uludag University School of Medicine, Bursa, Turkey.

The authors have no financial or proprietary interest in the materials presented herein.

Address correspondence to Mehmet Baykara, MD, Uludag University Faculty of Medicine, Department of Ophthalmology, 16059, Gorukle, Bursa, Turkey.

10.3928/15428877-20100215-28

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