Transcorneal extrusion of a posterior chamber intraocular lens: An unusual presentation of intraocular lens dislocation

Shukla, Manoj Kumar; Saleem, Akbar; Vakil, Asif Amin; Shukla, P.

doi:10.4103/0301-4738.37584

Cited by 2 publications

(2 citation statements)

References 4 publications

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“…2,3 Trans-corneal exposure and extrusion of posterior chamber IOLs is a rare phenomenon, and to date has been described only in 2 cases. 4,5 In the first one (2008), trans-corneal IOL extrusion occurred in a patient with a history of extracapsular cataract extraction with a posterior chamber IOL who developed 12 years later a corneal ulcer and subsequent corneal melting with IOL extrusion via this route. 4 In the second case (2021), IOL extrusion occurred via the donor cornea 8 years after a penetrating keratoplasty (PK) performed for bullous keratopathy and complicated later with glaucoma and graft failure.…”

Section: Introductionmentioning

confidence: 99%

“…4,5 In the first one (2008), trans-corneal IOL extrusion occurred in a patient with a history of extracapsular cataract extraction with a posterior chamber IOL who developed 12 years later a corneal ulcer and subsequent corneal melting with IOL extrusion via this route. 4 In the second case (2021), IOL extrusion occurred via the donor cornea 8 years after a penetrating keratoplasty (PK) performed for bullous keratopathy and complicated later with glaucoma and graft failure. 5 We report herein 2 unique cases of spontaneous 3-piece IOL extrusion through a Gundersen conjunctival flap, performed for tectonic purposes after multiple failed PKs, in the absence of history of ocular trauma.…”

Section: Introductionmentioning

confidence: 99%

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Spontaneous intraocular lens extrusion through Gundersen conjunctival graft after multiple failed keratoplasties: A report of two cases

Giannaccare

Nadeem

Vaccaro

et al. 2022

European Journal of Ophthalmology

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Purpose To report the occurrence and the outcomes of 2 cases of spontaneous extrusion of 3-piece intraocular lens (IOL) through a Gundersen conjunctival flap performed for tectonic purposes after multiple failed penetrating keratoplasties (PKs). Methods A 70-year-old woman (Patient #1) with severe dry eye disease who had undergone cataract surgery with posterior chamber 3-piece IOL implantation, multiple PKs and Gundersen conjunctival flap in her left eye presented with partial extrusion of the optic and the inferior haptic of the IOL through the conjunctival flap. Inferior symblepharon and keratinization of the entire ocular surface were also present. A 64-year-old diabetic man (Patient #2) with history of cataract surgery with a posterior chamber IOL implantation, multiple PKs for keratoconus and Gunderson conjunctival flap in his right eye presented with partial extrusion of IOL optic through the conjunctival flap. Results Patient #1 refused a further surgery and IOL was removed at the slit lamp. Currently, 3 months after IOL extrusion, corneal perforation self-sealed, visual acuity of light perception is maintained, and the patient does not complain any symptoms of ocular discomfort or pain. In Patient #2, tectonic PK combined with IOL removal and anterior vitrectomy was performed. Currently, 1 month postoperatively corneal graft is clear, intraocular pressure is normal, and patient's vision is counting fingers. Conclusions In both cases, IOL extrusion occurred spontaneously through a Gunderson conjunctival flap. Including the underlying Tenon's capsule in the conjunctival graft could increase its tectonic support, potentially avoiding this complication.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Spontaneous intraocular lens extrusion through Gundersen conjunctival graft after multiple failed keratoplasties: A report of two cases

Giannaccare

Nadeem

Vaccaro

et al. 2022

European Journal of Ophthalmology

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Intra-ocular lens extrusion in a patient with corneal graft melting

Errera

Gomart

Lindner

et al. 2021

American Journal of Ophthalmology Case Reports

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Purpose Postoperative extrusion of an intraocular lens at a site unrelated to the surgical incision is a very rare complication. We report the case of a posterior chamber intraocular lens extrusion through the cornea eight years after a penetrating keratoplasty in a patient with spontaneous aseptic stromal melting. Observation A 77-year-old man was treated for pseudophakic bullous keratopathy with a penetrating keratoplasty complicated by chronic graft rejection and severe glaucoma. He referred to our emergency department eight years after the surgery. The examination showed that the pseudophakic lens optic had eroded completely through the donor cornea. The globe remained intact during the extrusion process. The patient underwent excision of the pre-intraocular lens tissue, removal of intraocular lens implant and capsular bag, liberation of synechia, anterior vitrectomy and corneal graft under general anesthesia. There was no complication during or after the surgery. Histologic study suggests that the intraocular lens optic was covered by conjunctival epithelium with malpighian metaplasia. Conclusion To our knowledge, it's the first case of posterior chamber intraocular extrusion through ocular tissues following penetrating keratoplasty. This case emphasizes the importance of early identification of risk factors, strong postoperative follow up and good patient compliance and the need to minimize drug and surgery-induced iatrogenic effects. If the complication does ensue, early surgical intervention may prevent or minimize serious damage.

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Transcorneal extrusion of a posterior chamber intraocular lens: An unusual presentation of intraocular lens dislocation

Cited by 2 publications

References 4 publications

Spontaneous intraocular lens extrusion through Gundersen conjunctival graft after multiple failed keratoplasties: A report of two cases

Spontaneous intraocular lens extrusion through Gundersen conjunctival graft after multiple failed keratoplasties: A report of two cases

Intra-ocular lens extrusion in a patient with corneal graft melting

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