A 26-year-old man was referred to us from an outside hospital for management of an injury to the left eye sustained 2 weeks prior in a traffic accident. The patient also reported a history of blunt trauma with a cricket ball 2 years earlier, cataract extraction, and IOL implantation, all in the left eye.

Upon slit-lamp examination, aphakia and a traumatic iris with a dilated and fixed pupil were noted (Figure 1). Dilated fundus examination showed macular scarring—most likely a result of the previous blunt trauma—and a Kelman Multiflex–type anterior chamber IOL freely moving in the posterior vitreous cavity (Figure 2). We performed a pars plana vitrectomy and anterior chamber IOL explantation, along with implantation of a scleral-fixated IOL with single-pass four-throw pupilloplasty in the same sitting.

<p>Figure 1. Slit-lamp examination revealed aphakia and a traumatic iris with a dilated and fixed pupil. </p>

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Figure 1. Slit-lamp examination revealed aphakia and a traumatic iris with a dilated and fixed pupil. 

DISCUSSION

Ocular trauma is relatively common. About one-fifth of adults experience ocular trauma at some point in their lives, and it occurs most frequently in men and young people.1

Trauma can affect the crystalline lens in several ways. The lens can be partially displaced from its natural position (subluxated) or completely dislocated (luxated). A subluxated or luxated lens can move forward, resulting in angle-closure glaucoma. Injury to the lens may also lead to phacomorphic, lens-particle, or phacoantigenic glaucoma.2

Traumatic lens injury is usually managed by removing the lens with or without IOL implantation, depending upon the integrity of the anterior chamber structures and zonules.3

A posterior chamber IOL may be implanted within the capsular bag, if possible, with or without capsular support rings or segments; or it can be sutured or glued to the sclera. An anterior chamber or iris fixated IOL can be implanted in the event of significant zonular damage.4

<p>Figure 2. Macular scarring and a Kelman Multiflex–type anterior chamber IOL freely moving in the posterior vitreous cavity were observed on dilated fundus examination. </p>

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Figure 2. Macular scarring and a Kelman Multiflex–type anterior chamber IOL freely moving in the posterior vitreous cavity were observed on dilated fundus examination. 

Often, inadequate preoperative evaluation and incomplete surgical management may lead to postoperative IOL displacement, requiring repeat surgery.5,6 In our patient’s case, a subsequent traffic accident possibly caused the anterior chamber IOL—which may not have been adequately stabilized—to dislocate posteriorly through his dilated pupil.

When surgery for a dislocated IOL is planned, the surgeon should explain to the patient the risks and benefits of the procedure, including a guarded prognosis and a possible need for further interventions.7

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1. Serna-Ojeda JC, Cordova-Cervantes J, Lopez-Salas M, et al. Management of traumatic cataract in adults at a reference center in Mexico City. Int Ophthalmol. 2015;(35):451-458.

2. Mian SI, Azar DT, Colby K. Management of traumatic cataracts. Int Ophthalmol Clin. 2002;42(3):23-31.

3. Blum M, Tetz MR, Greiner C, Voelcker HE. Treatment of traumatic cataracts. J Cataract Refract Surg. 1996;22(3):342-346.

4. Synder A, Kobielska D, Omulecki W. [Intraocular lens implantation in traumatic cataract]. Klin Oczna. 1999;101(5):343-346 [in Polish].

5. Sitompul R. Intraocular lens dislocation after cataract surgery in Tambolaka, Southwest Sumba, Indonesia: a case report. Case Rep Ophthalmol. 2018;9(1):179-184.

6. Esquenazi S. Management of a displaced angle-supported anterior chamber intraocular lens. Ophthalmic Surg Lasers Imaging. 2006;37(1):65-67.

7. Cohen SM. Dislocated posterior chamber intraocular lens management. Retina Today. 2013;58-66.