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Breno R. Lima, Brandy Hayden, Jonathan Eisengart, Careen Y. Lowder; Ocular Complications Of Misplaced Intraocular Lens Haptics. Invest. Ophthalmol. Vis. Sci. 2011;52(14):6227.
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To review the clinical features, management and ultrasound biomicroscopy (UBM) findings of patients presenting with misplaced intraocular lens haptics.
UBM using a 50-MHz probe was performed in fourteen pseudophakic eyes, clinically suspected to have misplaced intraocular lens haptics. Patients were referred to our institution from May 2009 through September 2010, due to chronic postoperative inflammation, recurrent hyphema, increased intraocular pressure (IOP) or recurrent vitreous hemorrhage or a combination of those. The position of the intraocular lens haptics and their relationships to the surrounding anterior segment structures were determined. Clinical presentation and management of each patient were further reviewed.
Time from cataract surgery to referral/diagnosis of misplaced haptics by UBM ranged from 2 to 144 months (mean 57 ± 48 months). Seven patients (50%) had sulcus-implanted intraocular lens and seven (50%) had an in-the-bag intraocular lens. Six patients (42.8%) had a history of chronic post-operative inflammation. Five patients (35.7%) had recurrent episodes of hyphema. Elevated IOP was found in nine eyes (64.8%). A history of recurrent vitreous hemorrhages was elicited in eight patients (57.1%). Intraocular lens haptics misplacement was confirmed by UBM in all suspected cases. In twelve eyes, at least one haptic was embedded in or touching the iris. Haptic extension into the ciliary body process was observed in two patients, and into the pars plana in another. Focal iris thinning/atrophy was detected by UBM in three cases. Focal angle closure associated with haptic misplacement was found in four eyes. Intraocular lens exchange was performed in four cases. Out of the nine patients who presented with elevated IOP, seven had it controlled with topical IOP-lowering medications. Two patients were maintained on cycloplegics and topical steroids.
Ultrasound biomicroscopy is a valuable tool in confirming the clinical suspicion of misplacement of the lens haptics and haptic-induced ocular irritation after cataract surgery. This disorder may remain undiagnosed for several months, mimicking other conditions. Imaging findings, along with the presenting features, are essential in assisting the physician in the decision-making process of management of these patients.
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