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OPHTHALMIC IMAGE
Year : 2022  |  Volume : 60  |  Issue : 4  |  Page : 331

A saving grace or nuisance/preloaded iol-induced zonular dialysis due to sudden jolting during IOL ejection in a pseudoexfoliation patient with no preoperative phacodonesis


1 Department of General Ophthalmology, Mahathma Eye Hospital Private Limited, Trichy, Tamil Nadu, India
2 Department of Glaucoma and Research, Mahathma Eye Hospital Private Limited, Trichy, Tamil Nadu, India
3 Department of Cataract and Refractive Surgery, Mahathma Eye Hospital Private Limited, Trichy, Tamil Nadu, India
4 Department of Optometry and Visual Sciences, Mahathma Eye Hospital Private Limited, Trichy, Tamil Nadu, India
5 Chief Medical Officer, Mahathma Eye Hospital Private Limited, Trichy, Tamil Nadu, India

Date of Submission15-Nov-2021
Date of Decision22-Jul-2022
Date of Acceptance15-Aug-2022
Date of Web Publication19-Dec-2022

Correspondence Address:
Prasanna Venkatesh Ramesh
Mahathma Eye Hospital Private Limited, No. 6, Tennur, Seshapuram, Trichy - 620 017, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/tjosr.tjosr_175_21

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How to cite this article:
Varsha V, Ramesh PV, Ramesh SV, Ray P, Rajasekaran R, Ramesh MK. A saving grace or nuisance/preloaded iol-induced zonular dialysis due to sudden jolting during IOL ejection in a pseudoexfoliation patient with no preoperative phacodonesis. TNOA J Ophthalmic Sci Res 2022;60:331

How to cite this URL:
Varsha V, Ramesh PV, Ramesh SV, Ray P, Rajasekaran R, Ramesh MK. A saving grace or nuisance/preloaded iol-induced zonular dialysis due to sudden jolting during IOL ejection in a pseudoexfoliation patient with no preoperative phacodonesis. TNOA J Ophthalmic Sci Res [serial online] 2022 [cited 2023 Feb 8];60:331. Available from: https://www.tnoajosr.com/text.asp?2022/60/4/335/364235



A 65-year-old male with immature cataract and pseudoexfoliation (PXF) underwent uneventful phacoemulsification [Figure 1]a and [Figure 1]b. During implantation of SupraPhob (Appasamy, Chennai, India) preloaded intraocular lens (IOL), superior zonular dialysis (ZD) occurred due to two jolting jerks [Video 1][Additional file 1] of the foldable IOL that were caused during unfolding from the cartridge at the IOL implantation step. The distribution of the sudden jolting forces inferiorly, caused a superior ZD while undergoing ejection from the catridge [Figure 1c and d]. There was no vitreous disturbance, which was confirmed by the triamcinolone acetate staining. A capsular tension ring was inserted, culminating with a well-centred IOL in the stable bag. Though preloaded delivery systems are advantageous, ZD in a patient with no preoperative phacodonesis or issue with nucleotomy management has never been reported before.[1],[2],[3] Preloaded IOLs should be used in PXF patients with utmost caution.
Figure 1: (a) Intraoperative image showing immature senile cataract with PXF material in the anterior lens capsule (green arrow) with mid-dilated pupil. (b) Image showing a post-cataract extracted eye with well-centred capsulorhexis (green arrow), depicting an uneventful surgery. (c) Image showing sudden jolting ejection of the intraocular lens during implantation of SupraPhob preloaded IOL. (d) Image showing zonular dehiscence in the superior quadrant (green arrow) post-IOL implantation. IOL = intraocular lens, PXF = pseudoexfoliation

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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 his names and initials will not be published and due efforts will be made to conceal his identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Chung B, Lee H, Choi M, Seo KY, Kim EK, Kim TI. Preloaded and non-preloaded intraocular lens delivery system and characteristics: Human and porcine eyes trial. Int J Ophthalmol 2018;11:6-11.  Back to cited text no. 1
    
2.
Ramesh SV, Ramesh PV, Rajasekaran R, Ramesh MK. Pulp fiction of optic crack-The imperative irony of reloading a preloaded intraocular lens. Indian J Ophthalmol Case Rep 2021;1:402-4.  Back to cited text no. 2
  [Full text]  
3.
Naumann GO, Schlötzer-Schrehardt U, Küchle M. Pseudoexfoliation syndrome for the comprehensive ophthalmologist: Intraocular and systemic manifestations. Ophthalmology 1998;105:951-68.  Back to cited text no. 3
    


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