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 Table of Contents  
PHOTO ESSAY
Year : 2022  |  Volume : 60  |  Issue : 1  |  Page : 108-109

The popped-out intraocular lens: A case of posterior chamber intraocular lens extrusion


1 Department of General Ophthalmology, Aravind Eye Hospital, Madurai, Tamil Nadu, India
2 Department of Cataract and IOL Services, Aravind Eye Care System, Madurai, Tamil Nadu, India

Date of Submission25-Aug-2021
Date of Acceptance26-Oct-2021
Date of Web Publication22-Mar-2022

Correspondence Address:
Dr. Harinikrishna Balakrishnan
Department of General Ophthalmology, Aravind Eye Hospital, No. 1, Anna Nagar, Madurai - 625 020, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/tjosr.tjosr_133_21

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  Abstract 


A 70-year-old female with uncontrolled diabetes mellitus presented with complaints of defective vision in the left eye for 3 weeks. History revealed vigorous rubbing of LE followed by defective vision and use of self-prescribed antibiotic drops without ophthalmic consultation. The patient denied any history of trauma. She had undergone cataract surgery with posterior chamber intraocular lens (PCIOL) implantation 6 years back. Examination revealed poor ocular hygiene, blepharitis, and transcorneal extrusion of the PCIOL. The IOL was removed under strict aseptic conditions under antibiotic cover. Social neglect, repeated eye rubbing due to blepharitis and uncontrolled diabetes could have been the underlying cause for the painless extrusion of the PCIOL. Uncontrolled diabetes mellitus leads to corneal neuropathy characterized by decreased corneal sensitivity, recurrent erosions, corneal ulceration, and melting. This case signifies the importance of maintaining proper ocular hygiene, strict control of diabetes mellitus, and the use of appropriate ocular medications.

Keywords: Blepharitis, intraocular lens extrusion, uncontrolled diabetes, vigorous rubbing


How to cite this article:
Balakrishnan H, Ravindran S. The popped-out intraocular lens: A case of posterior chamber intraocular lens extrusion. TNOA J Ophthalmic Sci Res 2022;60:108-9

How to cite this URL:
Balakrishnan H, Ravindran S. The popped-out intraocular lens: A case of posterior chamber intraocular lens extrusion. TNOA J Ophthalmic Sci Res [serial online] 2022 [cited 2022 Jul 2];60:108-9. Available from: https://www.tnoajosr.com/text.asp?2022/60/1/108/340348



A 70-year-old female presented with complaints of defective vision in the left eye for 3 weeks. The patient had mild irritation in LE and vigorously rubbed her eyes 3 weeks back following which she developed defective vision. The patient denied any history of trauma. She had been using self-prescribed antibiotic eye drops procured from a nearby medical shop without any ophthalmic consultation. The patient has diabetes mellitus since 10 years which has been uncontrolled for the past 4 years. She had undergone cataract extraction with implantation of posterior chamber intraocular lens (PCIOL) 6 years back. On examination, the patient appeared emaciated. Best-corrected visual acuity in the LE was hand movements. Ocular examination revealed poor ocular hygiene, blepharitis, and extrusion of the intraocular lens through a central area of corneal melt. The optic of the 3-piece IOL was completely exposed with the haptics loosely fit in the ocular tissue [Figure 1]. The IOL was removed under strict aseptic conditions under antibiotic cover [Figure 2]. The culture and sensitivity tests remained inconclusive due to contamination caused by long period of exposure. Systemic workup revealed high blood glucose levels; HbA1c was found to be 12.0 and negative for autoimmune diseases. Transcorneal extrusion of PCIOL is extremely rare and can occur in cases of severe corneal thinning due to peripheral ulcerative keratitis or trauma.[1],[2] Social neglect, repeated eye rubbing due to blepharitis, and uncontrolled diabetes could have been the underlying causes for the painless extrusion.[1] Uncontrolled diabetes mellitus leads to corneal neuropathy characterized by decreased corneal sensitivity, recurrent erosions, corneal ulceration, and melting.[3]
Figure 1: Anterior segment photograph of posterior chamber intraocular lens extruding through cornea

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Figure 2: Three-piece posterior chamber intraocular lens explanted from the eye

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Our case exemplifies the effect of uncontrolled diabetes mellitus on the cornea. It also signifies the need for awareness among patients regarding consequences of poor diabetic control, need for proper ocular hygiene, and avoidance of self-medications.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
AlQahtani B, Abdelaal A, Karamallah E. Spontaneous cataractous lens extrusion in a patient with corneal melting. Case Rep Ophthalmol 2020;11:177-80.  Back to cited text no. 1
    
2.
Shukla M, Saleem A, Vakil AA, Shukla P. Transcorneal extrusion of a posterior chamber intraocular lens: An unusual presentation of intraocular lens dislocation. Indian J Ophthalmol 2008;56:82-3.  Back to cited text no. 2
[PUBMED]  [Full text]  
3.
Zhao H, He Y, Ren YR, Chen BH. Corneal alteration and pathogenesis in diabetes mellitus. Int J Ophthalmol 2019;12:1939-50.  Back to cited text no. 3
    


    Figures

  [Figure 1], [Figure 2]



 

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