| Popis: |
A 45-year-old man was originally referred for management of spontaneous subluxation of the inferior haptic of a 3-piece intraocular lens (IOL) into the anterior chamber of the right eye (). He had a significant past ocular history of laser-assisted laser in situ keratomileusis (LASIK) in both eyes, pars plana vitrectomy/scleral buckle for retinal detachment repair in the right eye, and pseudophakia in both eyes. The corrected distance visual acuity was 20/200 in the right eye and 20/20 in the left eye. Of note, he had severe iridodonesis, a 2+ pigmented cell in the anterior chamber without significant pseudophacodonesis and the posterior capsule was intact with striae. The referring physician attempted a refixation surgery that failed, and the patient was ultimately left aphakic.Next, a secondary 3-piece posterior chamber (PC) IOL (CT Lucia 602, Carl Zeiss Meditec AG) was fixated with the Yamane flanged intrascleral haptic fixation technique (ISHF). A surgical peripheral iridotomy (PI) was made with the vitrector to avoid pupillary capture postoperatively.On postoperative day 1 the patient had a well-centered PC IOL and uncorrected distance visual acuity (UCVA) of 20/30. However, on postoperative day 14 the patient complained of decreased vision as the UCVA dropped to 20/100 and pupillary capture of the optic was noted. In addition, there was a 3+ pigmented cell in the anterior chamber, pigment dusting on the anterior surface of the PC IOL, and an intraocular pressure (IOP) of 32 mm Hg ().What additional testing would you consider? How would you manage this patient's problem? |
