Recurrent scleral-fixated intraocular lens dislocation with spontaneous repositioning produced by tilting and head movements

Abstract

Introduction: An unusual case of a patient who could repeatedly reposition his dislocated sulcus poly(methyl methacrylate) intraocular lens (IOL) by head movements and tilting his body is reported. Patient and clinical findings: An 86-year-old man presented with a 3-year history of recurrent episodes of transient blurred vision and monocular diplopia in his left eye. 20 years previously, he had phacoemulsification cataract surgery complicated by posterior capsule tear, which was treated with anterior vitrectomy and a secondary scleral-fixated IOL. Over the previous 3 years, he had recurrent episodes of IOL dislocation. He could regain normal vision by tilting his head and trunk. The dislocated IOL was maneuvered into position by capturing the haptic into the residual capsular remnant by appropriate head movements. On examination, his corrected distance visual acuity (CDVA) was counting fingers, and the posterior chamber IOL was subluxated inferiorly. During presentation, he could not reposition it himself, warranting a surgical intervention. Diagnosis, intervention and outcomes: He underwent suturing of the IOL in the sulcus. The IOL was well-centered with a CDVA of 6/9. Conclusions: To the authors’ knowledge, this is the first case report of a patient who could repeatedly reposition a dislocated IOL through tilting and head movements.