Intra-ocular lens extrusion in a patient with corneal graft melting

Abstract

Purpose Postoperative extrusion of an intraocular lens at a site unrelated to the surgical incision is a very rare complication. We report the case of a posterior chamber intraocular lens extrusion through the cornea eight years after a penetrating keratoplasty in a patient with spontaneous aseptic stromal melting. Observation A 77-year-old man was treated for pseudophakic bullous keratopathy with a penetrating keratoplasty complicated by chronic graft rejection and severe glaucoma. He referred to our emergency department eight years after the surgery. The examination showed that the pseudophakic lens optic had eroded completely through the donor cornea. The globe remained intact during the extrusion process. The patient underwent excision of the pre-intraocular lens tissue, removal of intraocular lens implant and capsular bag, liberation of synechia, anterior vitrectomy and corneal graft under general anesthesia. There was no complication during or after the surgery. Histologic study suggests that the intraocular lens optic was covered by conjunctival epithelium with malpighian metaplasia. Conclusion To our knowledge, it's the first case of posterior chamber intraocular extrusion through ocular tissues following penetrating keratoplasty. This case emphasizes the importance of early identification of risk factors, strong postoperative follow up and good patient compliance and the need to minimize drug and surgery-induced iatrogenic effects. If the complication does ensue, early surgical intervention may prevent or minimize serious damage.

Spontaneous intraocular lens extrusion through Gundersen conjunctival graft after multiple failed keratoplasties: A report of two cases

“…2,3 Trans-corneal exposure and extrusion of posterior chamber IOLs is a rare phenomenon, and to date has been described only in 2 cases. 4,5 In the first one (2008), trans-corneal IOL extrusion occurred in a patient with a history of extracapsular cataract extraction with a posterior chamber IOL who developed 12 years later a corneal ulcer and subsequent corneal melting with IOL extrusion via this route. 4 In the second case (2021), IOL extrusion occurred via the donor cornea 8 years after a penetrating keratoplasty (PK) performed for bullous keratopathy and complicated later with glaucoma and graft failure.…”

“…4 In the second case (2021), IOL extrusion occurred via the donor cornea 8 years after a penetrating keratoplasty (PK) performed for bullous keratopathy and complicated later with glaucoma and graft failure. 5 We report herein 2 unique cases of spontaneous 3-piece IOL extrusion through a Gundersen conjunctival flap, performed for tectonic purposes after multiple failed PKs, in the absence of history of ocular trauma. Patients’ clinical course along with detailed corneal imaging are presented and discussed.…”