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

Abstract

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

Corneal edema after phacoemulsification

“…A distal haptic fragment was seen in the inferior AC angle which originated from the temporal haptic and had a clean, flat surface, suggesting it was severed by a sharp object due to improper implantation. [ 27 ] These cases are often managed in two stages. First stage includes the explanation of the unstable IOL or retained IOL fragments with or without IOL implantation in sulcus if adequate or intrascleral haptic fixation.…”

Partial Loss of Lens Haptic during Injection of Hydrophilic Intraocular Lens

“…It remains unclear whether such microlesions of lens optics are of clinical significance. Trapping or tearing of lens haptics is a complication that occurred with the introduction and wide use of lens shooter systems 9 , 11 , 12 , 13 , 14 , 15 , 16 . Whereas most authors reported this as a casuistic event, Koçluk et al 16 evaluated that trapping of a haptic occurred in his practice in 2.5% of all cases, a surprisingly high incidence.…”