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M. Connor, D. Downer, H.-J. Park, S. Tuli; Non-Traumatic Dislocation of a First Generation Phakic Intraocular Lens. Invest. Ophthalmol. Vis. Sci. 2007;48(13):5429.
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To describe non-traumatic dislocation of a first generation Fyodorov phakic intraocular lens.
A 56 year old Russian female presented to our clinic complaining of pain, tearing, photophobia and decreased vision in her left eye for approximately one week. Her symptoms began upon awakening. She denied any history of trauma. Her ocular history was significant for high myopia and implantation of a phakic intraocular lens (PIOL) in her left eye in Russia approximately 15 years ago.On examination, her visual acuity was 20/80 OD and hand motion at two feet OS. She had a slit-like pupil in the left eye. Slit lamp examination of the right eye was significant for RK scars and moderate nuclear sclerosis. The left eye showed a hazy cornea with epithelial and stromal edema. A dislocated PIOL trapped in the pupillary margin with a portion of the inferior haptic touching the corneal endothelium was noted. There was mild inflammation and a visually significant cataract.
Our patient had corneal decompensation secondary to lens-corneal touch from a dislocated posterior chamber phakic intraocular lens. She subsequently underwent lens explantation. The lens was identified as a first generation Fyodorov "mushroom" lens.
Phakic intraocular lenses are elegant ways of correcting refractive error in patients with high myopia. Known complications include: retinal detachment, corneal endothelial cell loss, cataract, and many others. To our knowledge, this represents the first report of non-traumatic anterior dislocation of a posterior PIOL. The mechanism of lens dislocation in this patient is unclear; however, we speculate that nocturnal mydriasis combined with valsalva maneuver, such as coughing, may have contributed to the haptics being displaced anteriorly. While any intraocular lens may dislocate with trauma, posterior PIOLs may be more susceptible to spontaneous dislocation as they float on the crystalline lens and are not secure. As PIOLs gain popularity, we may see more cases of similar dislocation even with the newer generation lenses.
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