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OPHTHALMIC IMAGE
Year : 2022  |  Volume : 60  |  Issue : 1  |  Page : 119-120

Complete late intraocular lens-bag complex dislocation into anterior chamber


Department of Cataract Services, Aravind Eye Hospital, Coimbatore, Tamil Nadu, India

Date of Submission20-May-2021
Date of Decision01-Oct-2021
Date of Acceptance07-Oct-2021
Date of Web Publication22-Mar-2022

Correspondence Address:
Dr. Bala D Saraswathy
Aravind Eye Hospital, Civil Aerodrome Post, Sitra, Coimbatore - 641 014, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/tjosr.tjosr_69_21

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How to cite this article:
Saraswathy BD, Narendran K. Complete late intraocular lens-bag complex dislocation into anterior chamber. TNOA J Ophthalmic Sci Res 2022;60:119-20

How to cite this URL:
Saraswathy BD, Narendran K. Complete late intraocular lens-bag complex dislocation into anterior chamber. TNOA J Ophthalmic Sci Res [serial online] 2022 [cited 2022 Jul 2];60:119-20. Available from: https://www.tnoajosr.com/text.asp?2022/60/1/119/340372



A 57-year-old male came with complaints of defective vision in the left eye for the past 6 months. He had no history of systemic illness. He had a history of uneventful phacoemulsification surgery in the left eye 5 years back, also had a history of idiopathic intermediate uveitis in both eyes for the past 7 years and on long-term treatment with steroids and mycophenolate mofetil. Vision in the left eye was 6/60 not improving. On examination, the left eye showed complete dislocation of bag-intraocular lens (IOL) (single-piece foldable IOL) complex into the anterior chamber [Figure 1]a. Concentric fibrosed band on the anterior capsule with anterior capsular fibrosis was seen. No active uveitis was found in both eyes and intraocular pressure was normal. Fundus examination showed epiretinal membrane. The other eye showed pseudophakia with anterior capsular fibrosis and no decentration [Figure 1]b. As far as our research, this is the first case to be reported showing a complete bag-IOL complex dislocation into the anterior chamber spontaneously. The patient underwent IOL explantation with SFIOL and vision improved to 6/9 postoperatively.
Figure 1: (a) Left eye showing whole intraocular lens bag complex dislocation into anterior chamber, black arrow indicating concentric capsular fibrosis (b) right eye showing pseudophakia white arrow showing anterior capsular fibrosis

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One of the serious complications after an uneventful phacoemulsification surgery is IOL-bag complex dislocation which is very rare.[1] It can be either anterior or posterior dislocation which occurs spontaneously. Early dislocation is <3 months and late dislocation is more than 3 months.[2] Common causes are pseudoexfoliation, high myopia, post vitrectomy, intermediate uveitis, and retinitis pigmentosa.[3] Significant fibrotic changes of capsular bag and anterior capsular phimosis due to metaplasia of retained lens epithelial cells cause a constant centripetal force on the capsular bag. This causes progressive zonular weakness and complete late in the bag IOL-bag complex dislocation.[4] Most commonly seen in acrylic IOLs believed to be due to bio-incompatibility of IOL material in some individuals. Adequate capsulorrhexis, complete cleaning of the cortex, and minimal zonular stress prevent such complications.[5]

Declaration of patient consent

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

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Hayashi K, Hirata A, Hayashi H. Possible predisposing factors for in-the-bag and out-of-the-bag intraocular lens dislocation and outcomes of intraocular lens exchange surgery. Ophthalmology 2007;114:969-75.  Back to cited text no. 1
    
2.
Böke WR, Krüger HC. Causes and management of posterior chamber lens displacement. J Am Intraocul Implant Soc 1985;11:179-84.  Back to cited text no. 2
    
3.
Jehan FS, Mamalis N, Crandall AS. Spontaneous late dislocation of intraocular lens within the capsular bag in pseudoexfoliation patients. Ophthalmology 2001;108:1727-31.  Back to cited text no. 3
    
4.
Vasavada A, Singh R. Relationship between lens and capsular bag size. J Cataract Refract Surg 1998;24:547-51.  Back to cited text no. 4
    
5.
Bhattacharjee H, Bhattacharjee K, Das D, Singh M, Sukumar P, Misra DK. Pathology and immunohistochemistry of capsular bag in spontaneously late dislocated capsular bag-intraocular lens complex. Indian J Ophthalmol 2017;65:949-54.  Back to cited text no. 5
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