Bilateral recurrent dislocation of plate haptic intraocular lens.

Dear Editor,

The optically ideal location of an intraocular lens (IOL) is within the capsular bag. The bag gives the IOL long term stability and contributes to a good refractive outcome. A sulcus placed lens can decenter and can move forward causing iris chafing, uveitis, hemorrhage, or glaucoma.[1] Rarely the lens can dislocate into the anterior chamber and cause endothelial cell loss.[23]

A 26-year-old male was referred to us for management of bilateral IOL dislocation. Two years ago, he had undergone cataract extraction with IOL implantation in both eyes. In the last six months, he had developed difficulty in vision in both eyes twice. In both those occasions, the diagnosis of IOL dislocation was made and lens repositioning was done. One month ago, he developed the same problem for the third time and was referred to us for further management. On examination, the inferior segment of plate haptic lens was seen in the anterior chamber inferotemporally in both eyes [Figs. 1 and 2].

Figure 1

The inferior half of the plate haptic lens dislocated inferotemporally into the anterior chamber in the right eye

Figure 2

The dislocated lens in the left eye

The surgical steps were as follows (similar for both eyes): two side-port incisions were created at the limbus through which viscoelastic was injected to stabilize the anterior chamber. A Sinskey hook was used to tease open the capsular bag, after which the bag was opened in its entirety using an iris-repositer combined with viscodissection. Preexisting capsular tears were noted in both eyes. Finally, a single piece poly methyl methacrylate (PMMA) IOL was implanted in the bag under viscoelastic after removal of the plate haptic lens.

IOLs should ideally be placed inside the capsular bag. If there is a problem with the integrity of the capsular bag, then the lens can be placed in the sulcus and if required, with optic capture through the rhexis opening.[3] The most suitable lenses that can be placed in the sulcus are 3 piece intraocular lens or a single piece PMMA lens. A plate haptic lens is very unstable in the sulcus and therefore should not be placed outside the capsular bag. Such a lens in the sulcus can cause significant problems like uveitis glaucoma hyphema (UGH) syndrome,[45] decentration, and can rarely dislocate into the anterior chamber. The sulcus diameter in this patient was 11.7 and 11.9 in the right and left eye respectively. The plate haptic IOL used during the primary surgery was only 10.5 mm. This causes the repositioned lens in the sulcus to be freely mobile. Hence, a PMMA was placed after removal of plate haptic lens. A single piece 6-mm optic and 13.5-mm diameter PMMA lens was placed into the bag.

In conclusion, the capsular bag is essential for the long term stability of IOL This case clearly demonstrates the unsuitability of plate haptic IOLs for placement in the sulcus and the futility of repositioning a plate haptic IOL into the sulcus especially when the sulcus diameter is significantly larger than the diameter of the IOL.