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C. Foster, F. Anzaar, N. Jawed, D. Hinkle; Spontaneous Intraocular Lens In-The-Bag Dislocation. Invest. Ophthalmol. Vis. Sci. 2007;48(13):5428.
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To report on a case of spontaneous IOL-in-the-capsular-bag dislocation
Interventional case report
A 74 year old man who with a history of hypertension, hyperlipidemia, diabetes mellitus, idiopathic posterior uveitis, secondary glaucoma, myopic retinal degeneration and remote history of superior retinal tear that was treated with laser photocoagulation OD, presented to us with decreased vision upon awakening one morning. The patient reported no history of trauma. Medications included CellCept 2.5 g, Cosopt BID OU, prednisolone acetate BID OU, Lipitor 10 mg and Norvasc 10 mg. Past ocular history was significant for pars plana vitrectomy OS and bilateral PCIOLs that were implanted previously. The patient had a YAG capsulotomy OS, after which he developed macular edema, treated with prednisolone acetate OS q2h. 2 months later, he developed subretinal fluid with cystic changes and a choroidal neovascular membrane OD with leakage on fluorescein angiography. Intraocular Avastin was given, with resolution of the fluid 3 weeks later.On examination, his visual acuity OS was 20/100 and iridodonesis was obvious. The PCIOL, alongwith the entire capsular bag, was lying on the inferior retina. The patient underwent IOL removal, and an anterior chamber IOL implantation. 3 months later his vision was 20/50.
Spontaneous dislocation of the IOL-capsule complex is uncommon. Postulated risk factors include myopic males, uveitis, diabetes, and prior YAG capsulotomy. Our patient had all of these. A vitrectomy and anterior chamber IOL placement may restore functional visual acuity in such patients.
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