Intraocular lens Intraocular lens dislocation dislocation

secondary to secondary to haptic torsion haptic torsion Lawrence E. Lohman, MD Lawrence E. Lohman, MD FACSFACS

Matthew C. Willett, MDMatthew C. Willett, MD

Author InformationAuthor Information Lawrence E. Lohman, MD FACSLawrence E. Lohman, MD FACS

-Northeast Ohio Eye Surgeons-Northeast Ohio Eye Surgeons-Northeastern Ohio Universities -Northeastern Ohio Universities

College of College of MedicineMedicine

-Summa Health Systems-Summa Health Systems Matthew C. Willett, MDMatthew C. Willett, MD

-Summa Health Systems-Summa Health Systems Neither author has any financial disclosuresNeither author has any financial disclosures Special thanks to Marc Jones, MD who Special thanks to Marc Jones, MD who

assisted with the photos in this presentationassisted with the photos in this presentation

PurposePurpose An 80 year old female patient was An 80 year old female patient was

referred for evaluation and management referred for evaluation and management of a dislocated posterior chamber one of a dislocated posterior chamber one piece acrylic intraocular lens (Alcon piece acrylic intraocular lens (Alcon SA60AT). Initial surgery was 11 months SA60AT). Initial surgery was 11 months prior to referral. She suffered blunt prior to referral. She suffered blunt trauma to the eye 5 months post op and trauma to the eye 5 months post op and immediately thereafter noted immediately thereafter noted asymmetric glare surrounding lights asymmetric glare surrounding lights and blurred vision. The vision remained and blurred vision. The vision remained unchanged until the time of evaluation. unchanged until the time of evaluation.

Patient EvaluationPatient Evaluation On initial evaluation the best On initial evaluation the best

corrected visual acuity was corrected visual acuity was 20/400. The IOL was noted 20/400. The IOL was noted to be inferiorly dislocated to be inferiorly dislocated with prominent anterior with prominent anterior tilting of the superior optic tilting of the superior optic edge (figure right.) The edge (figure right.) The capsule appeared intact and capsule appeared intact and no vitreous was visible no vitreous was visible anterior to the lens. The anterior to the lens. The haptic at 10 o’clock haptic at 10 o’clock appeared to be located appeared to be located within the bag (arrows). within the bag (arrows). Marked opacification of the Marked opacification of the posterior capsule was noted. posterior capsule was noted. This allowed limited view of This allowed limited view of the posterior segment, the posterior segment, however the retina appeared however the retina appeared grossly intact. The patient grossly intact. The patient was scheduled for possible was scheduled for possible surgical lens repositioning surgical lens repositioning or exchange. or exchange.

ResultsResults The eye was explored in the operating room. After viscoelastic The eye was explored in the operating room. After viscoelastic

injection to expand the capsular bag (2,3,4), the superior edge of injection to expand the capsular bag (2,3,4), the superior edge of the lens optic was drawn inferiorly revealing torsion of the the lens optic was drawn inferiorly revealing torsion of the superior lens haptic within the bag (5,6) causing it to extend superior lens haptic within the bag (5,6) causing it to extend posteriorly and in a clockwise (rather than counter clockwise) posteriorly and in a clockwise (rather than counter clockwise) direction from the lens opticdirection from the lens optic

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4 5 6

1

ResultsResults Using a two handed technique, the haptic was reoriented to its Using a two handed technique, the haptic was reoriented to its

intended configuration (7-10) with immediate lens recentration intended configuration (7-10) with immediate lens recentration (11-14). One day after surgery the patient noted resolution of (11-14). One day after surgery the patient noted resolution of glare symptoms. After Yag capsulotomy BCVA remains 20/25 with glare symptoms. After Yag capsulotomy BCVA remains 20/25 with no glare symptoms and stable lens position.no glare symptoms and stable lens position.

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ConclusionsConclusions

A photographic record is presented of A photographic record is presented of a previously unreported case of a previously unreported case of traumatic haptic torsion of a one piece traumatic haptic torsion of a one piece acrylic IOL resulting in lens acrylic IOL resulting in lens dislocation. The problem was dislocation. The problem was corrected by reorienting the lens corrected by reorienting the lens haptic to its intended position within haptic to its intended position within the capsular bag, resulting in lens the capsular bag, resulting in lens recentration and resolution of patient recentration and resolution of patient symptoms. symptoms.

Lawrence Lohman MDLawrence Lohman MD Lawrence Lohman MD Lawrence Lohman MD

FACS is founder and FACS is founder and medical director of medical director of Northeast Ohio Eye Northeast Ohio Eye Surgeons where his Surgeons where his practice is limited to practice is limited to Cataract, Cornea and Cataract, Cornea and Refractive eye surgeries. Refractive eye surgeries. He is also founding He is also founding member and medical member and medical director at St Clare Eye director at St Clare Eye Surgery and Laser Center. Surgery and Laser Center. He teaches at SUMMA He teaches at SUMMA Hospitals Medical Center Hospitals Medical Center in Akron, Ohio and in Akron, Ohio and Northeast Ohio Northeast Ohio Universities College of Universities College of Medicine.  Medicine.