Stability Of Three Piece Iol With One Haptic Only In High Myopia

To report on a case of a long standing three piece IOL in the center of the capsular bag although with one haptic only. 

An 82 years-old patient with high myopia, exudative myopic maculopathy and corneal guttae underwent cataract surgery in IRCCS Istituto Auxologico Italiano. Her best corrected visual acuity was 20/200 with – 16,5 diopters. Axial length 30,57 millimeters.

During surgery, after the insertion of a three piece IOL, one haptic resulted damaged leading the surgeon to cut and remove the haptic itself instead of substitute the entire IOL. Scheduled controls on slit lamp examination evidenced complete recovery of the anterior segment in a few days. The IOL remained predominantly centered in the capsular bag alhough slightly dislocated inferiorly. The remaining haptic was oriented nasally. Visual acuity improved to 20/50 with – 2,5 diopters and patient satisfaction.  Ultrasound imaging and anterior segment OCT with topo-aberrometer technology were able to disclose a 7 ⁰ vertical tilting of the IOL plate with a higher order total aberrometry of 0,27 micron. At two years follow up, visual acuity with anterior segment examination and multi-modal imaging unchanged.

One three piece IOL could remain centered in the capsular bag of a myopic eye regardless the absence of one haptic.