This patient had cataract surgery about 2 months ago with a local ophthalmologist. She did well initially, achieving 20/20 vision with a plano refraction. But then over the course of the past month, the vision has steadily declined to 20/50 with a refraction of -0.50 -2.00 x 120 and monocular diplopia / ghosting. How did we fix this? (full video below)
When we look at the wavefront aberrometry scan, the cornea (middle panel below) looks pretty good, but the lens / internal scan shows induction of coma aberration (right panel below). The overall wavefront (left panel below) shows this same high degree of coma and aberration. This tell us that the issue is most likely with the lens / IOL.
We can see that this multi-focal IOL is decentered temporally at least a few millimeters and the IOL also appears to be tilted.
When we examine the eye using retro-illumination to enhance the red-reflex, we see an interesting trans-illumination defect. It is the perfect outline of the haptic of this single-piece acrylic multi-focal IOL.
When we have the patient look nasally and we aim our slit-lamp at the haptic-optic junction of the IOL, we can see that the nasal IOL haptic is above the capsular bag, in the sulcus, and rubbing against the back of the iris.
How do we fix it? Watch the narrated video below to see:
If you have a case of a dislocated IOL, remember to determine why it happens before you make a surgical plan.
Bonus Question:
(write your answer below as a comment)
check back tomorrow for a full article and video about Surgical Approach to the Dislocated IOL
Pseudoexfoliation .
Probable capsular tension ring/segment was not put during cat sx.
Sir,eager to see how u manage this case?
Yes, good thoughts. This patient does have pseudoexfoliation. Putting in a capsular tension ring probably would not have made much difference.
Because of Pseudoexfoliation IOL+ capsular bag has been subluxated. We are waiting to see how you are going to fix the whole IOL + capsular bag complex.
great answer. Yes, that video will be coming in the future.