Fracture of a polyimide–elastimide posterior chamber intraocular lens following blunt orbital trauma

Purpose: Fracture of a three-piece polyimide–elastimide intraocular lens at the optic–haptic junction following blunt trauma is a possible complication after cataract surgery. We report a case of an isolated posterior chamber intraocular lens fracture caused by direct ocular blunt trauma. Case: A 51-year-old patient underwent blunt orbital trauma caused by a raw chicken egg that was thrown at him, as he was walking. The posterior chamber intraocular lens was found in the anterior chamber, with a broken optic–haptic junction. The intraocular lens was exchanged, followed by iris fixation and pupilloplasty, with satisfactory postoperative anatomical and optical outcomes. Discussion: The three-piece polyimide–elastimide intraocular lens was fractured at the optic–haptic junction. Although the fractured intraocular lens surface had a regular appearance, it has been previously reported that the polyimide haptic’s durability is probably inferior to that of polymethylmethacrylate. Therefore, it is highly susceptible to shear stress induced by a blunt trauma. Conclusion: To our knowledge, this is an uncommon report of an implanted posterior chamber polyimide–elastimide intraocular lens fracture following blunt orbital trauma. Intraocular lens exchange and fixation had successful optical and anatomical results.

Trans-iris fixation of dislocated in-the-bag intraocular lenses

Purpose: The aim of this article is to describe the safety and efficacy of trans-iris suture fixation for the management of late dislocation of in-the-capsular-bag intraocular lenses following uncomplicated cataract surgery. Patients and methods: Eleven eyes of 11 patients with late in-the-capsular-bag intraocular lens dislocation following uneventful phacoemulsification cataract surgery were recruited in the study. The dislocated intraocular lens–capsular bag complex was sutured to the iris at two points 180° apart using 9-0 polypropylene sutures on long needles. Results: Mean patient age was 67 ± 6 years. Seven eyes had pseudoexfoliation syndrome, one eye had Marfan syndrome, and another eye had a traumatic cataract; no risk factor was identified for intraocular lens dislocation in two eyes. A capsular tension ring had been implanted during cataract surgery in four eyes. In six eyes, the posterior chamber intraocular lenses were one-piece foldable while the remaining were three-piece intraocular lenses. Compared to the preoperative value, corrected distance visual acuity was significantly improved postoperatively ( p < 0.005). Intraoperative hyphema occurred in two eyes. Pupil ovalization was observed in all eyes. Mean endothelial cell count decreased by 4 ± 1.7% after intraocular lens fixation. The capsular bag–intraocular lens complex was stable and well-centered in the pupillary area in all eyes at the final follow-up examination which was performed 16 ± 4 months postoperatively. Conclusion: Trans-iris fixation is a simple and effective procedure for management of late intraocular lenses–capsular bag complex dislocation, without major complications.

DRAINING AUTO VALVE LIMBOSCLERECTOMY IN POSTTRAUMATIC GLAUCOMA TREATMENT

The aim of the current article is to report the case of a patient with posttraumatic glaucoma who underwent a successful a draining auto valve limbosclerectomy (DALS) 6 months ago. A 65-year-old patient admitted on April 2017 with history of blunt left eye trauma. The diagnosis of severe eye contusion, Ectopia lentis and ocular hypertension was made. A subtotal vitrectomy, lensectomy and iris fixation of posterior chamber intraocular lense were performed the next day. A laser trabeculoplasty was performed 10 days after surgery for lowering IOP. During a follow-up examination, the patient was found high IOP in the left eye despite maximum IOP-lowering topical treatment. A draining auto valve limbosclerectomy (DALS) was performed in the left eye. The reduction in IOP has subsequently been maintained over six months of follow-up. This patient’s experience is a single case, yet it contributes to the evidence that a draining auto valve limbosclerectomy (DALS) may be high efficient in posttraumatic glaucoma treatment.