IMPLANTATION OF A SUTURELESS SCLERAL FIXATED HYDROPHILIC INTRAOCULAR LENS IN A PATIENT WITH A DISLOCATED IOL

To assess the effect of Neodymium-doped:Yttrium Aluminium Garnet (Nd:YAG) laser capsulotomy as a treatment for the posterior capsular opacification (PCO) in a dislocated intraocular lens (IOL).

^{A 70-year-old male underwent phacoemulsification in the right eye, complicated by posterior capsular rupture without drop of nuclear fragments into the vitreous cavity. A single piece intraocular lens (IOL) was placed in the bag.}

^{Five years after the surgery he referred to our emergency department for evaluation complaining about a painless, progressive loss of vision in his right eye, mild glare, halos and monocular diplopia in his right eye over the last three months. He had no significant past medical history, systemic illnesses, previous surgeries, or current medications. His Past Ocular History included only the phacoemulsification in his right eye five years ago.}

^{On examination, his Best-Corrected Visual Acuity (BCVA) was reported as 8/10 in his right eye and 9/10 in his left eye. Slit-lamp biomicroscopy of the anterior segment was unremarkable in both eyes. Cornea was clear, Anterior Chamber was deep and quiet without Vitreous loss, pupil was round and reactive in both eyes. Intraocular Pressure (IOP) measured 18mmHg in the right eye and 19mmHg in the left eye. Dilation of the pupil revealed a dislocated PC-IOL with Posterior Capsular Opacification (PCO) in the right eye and cataract in the left eye. Fundus examination was normal and the retina was flat bilaterally.}

^{Initial management included a Neodymium-doped:Yttrium Aluminium Garnet (Nd:YAG) laser capsulotomy for the posterior capsular opacification (PCO) with the aim of improving the blurred vision and dysphotopsia. An Nd:YAG laser posterior capsulotomy in the right eye was performed without complications. Visual acuity remained 8/10 in the right eye. One month later, he experienced an acute atraumatic loss of visual acuity in the right eye. Examination revealed that the IOL had dislocated inferiorly and posteriorly into the vitreous cavity. The patient underwent pars plana vitrectomy with removal of the dislocated single piece intraocular lens(IOL). The lens used was a sutureless scleral fixation Carlevale lens (I71 FIL SSF Carlevale lens™. Soleko IOL Division), which was delivered to the operating theatre on the morning of the operation.}

Patient should be informed that posterior dislocation is an infrequent but possible complication that may occur months and even years after the laser capsulotomy. The implant of the hydrophilic intraocular lens FIL SSF is suggested in the correction of aphakic eyes, in which adequate 
capsular support is absent. Hydrophilic intraocular lenses FIL SSF are designed to be implanted in the ciliary sulcus in case 
of absent capsular support, through the anchoring of self-blocking harpoons in scleral pockets and consequent covering of 
the harpoons by the scleral pockets.