Symptoms: A 53 YOM presents for a second opinion for cloudy vision post-cataract extraction for the past 3 months, and an interior pressure sensation OD for two months.
Signs: The patient had a history of cataract extraction (CE) with pc-IOL OD and OS, followed two weeks later by repositioning of a haptic that had migrated into the anterior chamber OD. Three weeks later, the patient experienced a PVD OD, followed by a retinal detachment in the same eye after seven weeks. One day post RD repair, the patient presented with a pain and pressure sensation OD, a hyphema, dilated pupil, and an intraocular pressure of 34 mm Hg. The patient also had monocular triplopia OD. OD pupil is fixed with no correctopia. Patient has difficulty driving at night, frequent injection OD and sensitivity to light OD. Biomicroscopy reveals malpositioned IOL with the temporal portion prolapsed into the anterior chamber OD, confirmed with anterior segment OCT.
Diagnosis: The patient was diagnosed with: Dislocated anterior IOL OD (379.33, H27.129), Acute Iridocyclitis OD (364.02, H20.011), and previous Retinal Detachment OD (361.01, H33.011).
Treatment: The retinal detachment was treated with a vitrectomy, scleral buckle and nitrogen gas bubble injection. The patient was prescribed topical prednisolone acetate 1% OD for the inflammation and light sensitivity, as well as Combigan BID OD and Travatan QD OD to lower the IOP. At this time, the patient is working with a cataract surgeon/corneal specialist to re-position the pc-IOL and hoping there will be no residual damage to the iris.
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