Intraocular lens dislocation secondary to haptic torsion Lawrence E. Lohman, MD FACS Matthew C. Willett, MD

Author Information Lawrence E. Lohman, MD FACS Lawrence E. Lohman, MD FACS -Northeast Ohio Eye Surgeons -Northeastern Ohio Universities College of Medicine Medicine -Summa Health Systems Matthew C. Willett, MD Matthew C. Willett, MD -Summa Health Systems Neither author has any financial disclosures Neither author has any financial disclosures Special thanks to Marc Jones, MD who assisted with the photos in this presentation Special thanks to Marc Jones, MD who assisted with the photos in this presentation

Purpose An 80 year old female patient was referred for evaluation and management of a dislocated posterior chamber one piece acrylic intraocular lens (Alcon SA60AT). Initial surgery was 11 months prior to referral. She suffered blunt trauma to the eye 5 months post op and immediately thereafter noted asymmetric glare surrounding lights and blurred vision. The vision remained unchanged until the time of evaluation. An 80 year old female patient was referred for evaluation and management of a dislocated posterior chamber one piece acrylic intraocular lens (Alcon SA60AT). Initial surgery was 11 months prior to referral. She suffered blunt trauma to the eye 5 months post op and immediately thereafter noted asymmetric glare surrounding lights and blurred vision. The vision remained unchanged until the time of evaluation.

Patient Evaluation On initial evaluation the best corrected visual acuity was 20/400. The IOL was noted to be inferiorly dislocated with prominent anterior tilting of the superior optic edge (figure right.) The capsule appeared intact and no vitreous was visible anterior to the lens. The haptic at 10 o’clock appeared to be located within the bag (arrows). Marked opacification of the posterior capsule was noted. This allowed limited view of the posterior segment, however the retina appeared grossly intact. The patient was scheduled for possible surgical lens repositioning or exchange. On initial evaluation the best corrected visual acuity was 20/400. The IOL was noted to be inferiorly dislocated with prominent anterior tilting of the superior optic edge (figure right.) The capsule appeared intact and no vitreous was visible anterior to the lens. The haptic at 10 o’clock appeared to be located within the bag (arrows). Marked opacification of the posterior capsule was noted. This allowed limited view of the posterior segment, however the retina appeared grossly intact. The patient was scheduled for possible surgical lens repositioning or exchange.

Results The eye was explored in the operating room. After viscoelastic injection to expand the capsular bag (2,3,4), the superior edge of the lens optic was drawn inferiorly revealing torsion of the superior lens haptic within the bag (5,6) causing it to extend posteriorly and in a clockwise (rather than counter clockwise) direction from the lens optic The eye was explored in the operating room. After viscoelastic injection to expand the capsular bag (2,3,4), the superior edge of the lens optic was drawn inferiorly revealing torsion of the superior lens haptic within the bag (5,6) causing it to extend posteriorly and in a clockwise (rather than counter clockwise) direction from the lens optic

Results Using a two handed technique, the haptic was reoriented to its intended configuration (7-10) with immediate lens recentration (11-14). One day after surgery the patient noted resolution of glare symptoms. After Yag capsulotomy BCVA remains 20/25 with no glare symptoms and stable lens position. Using a two handed technique, the haptic was reoriented to its intended configuration (7-10) with immediate lens recentration (11-14). One day after surgery the patient noted resolution of glare symptoms. After Yag capsulotomy BCVA remains 20/25 with no glare symptoms and stable lens position

Conclusions A photographic record is presented of a previously unreported case of traumatic haptic torsion of a one piece acrylic IOL resulting in lens dislocation. The problem was corrected by reorienting the lens haptic to its intended position within the capsular bag, resulting in lens recentration and resolution of patient symptoms. A photographic record is presented of a previously unreported case of traumatic haptic torsion of a one piece acrylic IOL resulting in lens dislocation. The problem was corrected by reorienting the lens haptic to its intended position within the capsular bag, resulting in lens recentration and resolution of patient symptoms.

Lawrence Lohman MD Lawrence Lohman MD FACS is founder and medical director of Northeast Ohio Eye Surgeons where his practice is limited to Cataract, Cornea and Refractive eye surgeries. He is also founding member and medical director at St Clare Eye Surgery and Laser Center. He teaches at SUMMA Hospitals Medical Center in Akron, Ohio and Northeast Ohio Universities College of Medicine. Lawrence Lohman MD FACS is founder and medical director of Northeast Ohio Eye Surgeons where his practice is limited to Cataract, Cornea and Refractive eye surgeries. He is also founding member and medical director at St Clare Eye Surgery and Laser Center. He teaches at SUMMA Hospitals Medical Center in Akron, Ohio and Northeast Ohio Universities College of Medicine.