Spontaneous intraocular lens extrusion in a patient with scleromalacia secondary to herpes zoster ophthalmicus

Abstract

We report a case of spontaneous intraocular lens (IOL) extrusion in association with scleromalacia 10 years after uneventful endocapsular surgery. The patient had a history of iridocyclitis secondary to herpes zoster ophthalmicus in the affected eye. A minimally invasive approach involving repositioning the IOL and closure with a conjunctival flap resulted in restoration of visual acuity.

Intermediate results of sutureless intrascleral posterior chamber intraocular lens fixation

“…Scleral tunnels are well known from cataract surgery, and we would not expect scleromalacia to occur except, possibly, in cases of preexisting inflammation (eg, scleritis, episcleritis, rheumatoid arthritis, herpes zoster ophthalmicus). [59][60][61][62][63][64] The tips of the haptics are buried, and to date we have not observed conjunctival erosion in any eye. The risk for chronic inflammation or recurrent bleeding is potentially lower than with other sulcus-fixated IOL techniques because of the minimum contact with uveal tissue.…”

Sutureless intrascleral posterior chamber intraocular lens fixation

“…Scleral tunnels are well known in cataract surgery procedures, and we do not expect scleromalacia except in cases of preexisting inflammations such as scleritis, episcleritis, rheumatoid arthritis, and herpes zoster ophthalmicus. [31][32][33] The tips of the haptics are buried so conjunctival erosion should not occur. The risk for chronic inflammation or recurrent bleeding is potentially lower than with any other sulcus-fixated IOL because there is no contact with the ciliary body.…”

Herpes zoster ophthalmicus and limbal ischemia in a patient with history of ocular graft-versus-host disease

“…reported a patient with scleromalacia after HZO infection that causes spontaneous intraocular lens extrusion. 15 Although rare, the most possible mechanism of damage to limbal vessels and subsequent limbal ischemia in our patient is occlusive limbal vasculitis caused by HZO infection predisposed by compromised immunity and ocular surface damage due to GVHD. Gungor et al .…”

“… 6 7 There are few case reports of such ischemic damages after HZO infection. 13 14 15 16 Kestelyn et al . reported anterior segment and limbal ischemia as a complication of HZO infection in human immunodeficiency virus-positive patient.…”