Scleral fixation of a posterior chamber intraocular lens in a patient with two dislocated lens implants

PURPOSE. To report the clinical findings and management of a case of two consecutive intraocular lenses (IOLs) dislocated into the vitreous cavity after complicated cataract surgery. METHODS. Review of clinical findings and treatment. RESULTS. A 69-year-old man sought treatment for posterior chamber IOL dislocation. The patient reported a significant loss of visual acuity in the right eye for 4 months (best-corrected visual acuity (BCVA) 20/200 in the affected eye). In the vitreous cavity two dislocated IOLs were found, complicated by a cystoid macula edema. Surgery was planned and the two IOLs were removed from the vitreous cavity. Aphakia was then corrected by means of a scleral fixated posterior chamber lens. Three months after surgery, BCVA was 20/40. CONCLUSIONS. In the absence of randomized controlled clinical trials evaluating treatment options, preoperative patient work-up should be as accurate as possible in order to reduce the risk of intraoperative and postoperative complications. In this patient, removing the two IOLs and placing a sutured-fixated posterior chamber IOL allowed resolution of the cystoid macular edema. (Eur J Ophthalmol 2004; 14: 149-52)