Secondary intrascleral intraocular lens (IOL) fixation with capsule preservation for IOL dislocation following mature cataract surgery with incomplete capsulorhexis: A case report.

RATIONALE

The objective of this study was to apply secondary intraocular lens (IOL) intrascleral fixation with lens capsule preservation in a patient with IOL dislocation following mature cataract surgery with incomplete continuous curvilinear capsulorhexis (CCC).

PATIENT CONCERNS

A 56-year-old Japanese woman experienced distorted vision 4 days after phacoemulsification and intracapsular IOL implantation for a mature cataract.

DIAGNOSES

Slit-lamp examination revealed inferior-nasal dislocation of the intracapsular IOL through an anterior capsule defect (3-6 o'clock) caused by peripheral extension of the CCC during the primary surgery.

INTERVENTIONS

IOL extraction followed by intrascleral fixation with lens capsule preservation was performed 1 week after the initial surgery. The secondary surgery involved inserting a 30 G needle between the lens capsule and iris, with IOL fixation to the sclera using a double-needle technique. The IOL optics were successfully captured through the incomplete anterior CCC of the preserved lens capsule. No intraoperative vitreous prolapse occurred, eliminating the need for a vitrectomy.

OUTCOMES

The IOL remained well-fixed without IOL pupillary capture. Additionally, no significant complications such as retinal detachment or vitreous hemorrhage were observed.

LESSONS

Preserving the capsule during secondary intrascleral fixation for IOL dislocation in patients with incomplete CCC offers several advantages, including reduced intraoperative vitreous prolapse, minimized surgical invasiveness, suppression of postoperative iris flutter, and prevention of IOL capture within the pupil. However, the long-term outcomes, including the potential risk of lens capsule drop, warrant further investigation with more cases.