Spontaneous dislocation of a phakic refractive lens into the vitreous cavity

Abstract

A 36-year-old woman with high myopia had uneventful implantation of a phakic refractive lens (PRL) bilaterally. Two months postoperatively, the best corrected visual acuity (BCVA) in the right eye decreased to the preoperative level and the posterior chamber PRL disappeared from the anterior segment and was found lying in the vitreous cavity inferiorly. After lensectomy and pars plana vitrectomy, the PRL was removed through the initial clear corneal incision, improving the BCVA to 1.0. A zonular defect associated with high myopia, previously forgotten and unrecognized ocular trauma, or intraoperative manipulations may have resulted in the spontaneous dislocation of the PRL.

Medium-term visual, refractive, and intraocular stability after implantation of a posterior chamber phakic intraocular lens to correct moderate to high myopia

“…This, combined with PC pIOL implantation, may lead to zonular dehiscence 18 and spontaneous dislocation of the PC pIOL into the vitreous cavity. 19 Although these complications did not occur in our series, 2 cases of pIOL decentration were detected on slitlamp examination. The decentration was not quantified or evaluated accurately using an advanced anterior segment imaging technique, such as AS-OCT or ultrasonography.…”

The posterior chamber phakic refractive lens (PRL): a review

“…42,48 In addition, any condition associated to a potential zonular weakening should be also considered as a contraindication for the implantation of PRL, such as history of ocular trauma with secondary zonular damage, Marfań s syndrome diagnosis, or other systemic illnesses characterized by fragility of the cilliary processes. 37 A preoperative evaluation of the zonule by means of ultrasound technology is recommended in order to confirm structural integrity. 49 Figure 1 Image of the PRL models for myopia (upper) and hyperopia (lower).…”

“…This may cause zonular dehiscence 25,26 and spontaneous dislocation of the PRL toward the vitreous cavity. 36,37 As with other types of pIOL, other potential complications have been also described, such as secondary uveitis, retinal detachment, 26 or choroidal neovascularization. 39 …”

Phakic intraocular lenses

“…Eleftheriadis et al 157 report a spontaneous dislocation of PRL 2 months after uneventful implantation into the vitreous cavity. Luxation was attributed to preexsisting zonular defect in the highly myopic eye and unrecognized ocular trauma.…”