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Nisha Chadha, Leslie Olsakovsky, Bryan Edgington; Upside-Down ACIOL placement: A case series on complications, management, and outcomes. Invest. Ophthalmol. Vis. Sci. 2013;54(15):3005. doi: https://doi.org/.
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The purpose of this study is to report cases of incorrect ACIOL placement and resultant complications as well as to increase awareness of proper insertion amongst ophthalmologists implanting these lenses.
A retrospective case series of consults for incorrect ACIOL implantation at two academic institutions.
Four patients presented to two university eye clinics with complaints of blurred vision in their pseudophakic eye after intraocular surgery. Examination revealed upside-down orientation of an ACIOL with posterior vaulting against the iris in all four patients and corneal edema in three of the four patients. The patient without corneal edema presented after complicated cataract surgery with count fingers vision and was also found to have her native lens present in the posterior chamber. She was scheduled to undergo intraocular lens exchange and pars plana lensectomy, but was lost to follow up. One of the three patients with corneal edema also presented after complicated cataract surgery with a VA of 4/200. He underwent penetrating keratoplasty (PK) and IOL exchange. He developed post-operative vitreous hemorrhage secondary to diabetic retinopathy and despite pars plana vitrectomy did not regain good vision, presumably due to ischemic changes in the retina. The second patient with corneal edema presented with VA of 5/600 after repair of traumatic retinal detachment during which the ACIOL dislocated into posterior chamber and was replaced incorrectly by the retina surgeon. He underwent PK with IOL repositioning. Vision was limited by macular folds. The third patient presented after repair of post-operative retinal detachment by endoscopic approach due to corneal haze with a VA of 20/200. He underwent PK and intra-operartively was found to have a malpositioned ACIOL. The ACIOL was repositioned and PK completed and his vision post-operative week two was 20/300.
Despite advancements in cataract surgery techniques and outcomes, there is still a need for ACIOL implantation at times. Infrequent use by ophthalmologists may lead to improper insertion. Physician awareness of proper ACIOL insertion can prevent vision threatening complications and need for additional surgery.
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