Case Report: Diagnosis of Late Spontaneous Intraocular Lens Dislocation on Point-of-care Ultrasound.
Ontology highlight
ABSTRACT: Introduction
Spontaneous intraocular lens (IOL) dislocation is a rare, but serious, complication following cataract surgery.Case report
We report a case of patient with a remote history of cataract surgery presenting to the emergency department with monocular blurred vision. Ocular point-of-care ultrasound (POCUS) facilitated diagnosis of a late spontaneous IOL dislocation.Discussion
Prosthetic IOL dislocations are being reported with increasing frequency. Prompt recognition of IOL dislocation is essential to prevent secondary complications, including acute angle-closure glaucoma and retinal detachment, which can result in permanent vision loss.Conclusion
Point-of-care ultrasound is a rapid, noninvasive imaging modality for early detection of IOL dislocation to help guide management, improve patient outcomes, and mitigate long-term sequelae.
SUBMITTER: Pizarro A
PROVIDER: S-EPMC8373180 | biostudies-literature |
REPOSITORIES: biostudies-literature
Similar Datasets
Project description:In this report, three cases with pseudoexfoliation (PEX) and advanced age with spontaneous intraocular lens (IOL) and capsule tension ring (CTR) dislocation were presented. All of our cases experienced progressive vision loss without an episode of strenuous physical activity, trauma, or any other ocular disease. Spontaneous dislocation was observed 2.5 to 8 years after uneventful phacosurgery. Each patient underwent complete IOL and CTR removal combined with anterior chamber IOL implantation. No complications were noticed during follow-up. As a result, capsule tension ring does not prevent late IOL dislocation after uncomplicated phacosurgery in the presence of PEX. Therefore, close follow-up is essential for patients with PEX.
| S-EPMC5384115 | biostudies-other
Project description:PurposeTo report a rare case of delayed dislocation of a novel posterior chamber phakic intraocular lens into the vitreous cavity, which was successfully treated by a reformed technique.Case presentationA 29-year-old female received Ejinn phakic refractory lens (EPRL) implantation to correct her high myopia. Spontaneous dislocation into the vitreous cavity occurred 26-months post-operatively without traumatic history. Pars plana vitrectomy combined with cutting the EPRL into two equal pieces was performed to remove the dislocated EPRL.ConclusionDislocation into the vitreous cavity of EPRL can be successfully and easily removed by our reformed technique. Concerns about zonules-related complications pre-operatively, intraoperatively, and post-operatively must be raised in the practice of EPRL implantation.
| S-EPMC8832095 | biostudies-literature
Project description:Late spontaneous in-the-bag intraocular lens (IOL) dislocation is a complication presenting 6 months or later after cataract surgery. We aimed to characterize the cells in the lens capsules (LCs) of 18 patients with spontaneous late in-the-bag IOL dislocation. Patients' average age was 82.6 ± 1.5 years (range 72-98), and most of them had pseudoexfoliation syndrome (PEX). Cells from the LCs were positive for myofibroblast (αSMA), proliferation (Ki-67, PCNA), early lens development/lens progenitor (SOX2, PAX6), chemokine receptor (CXCR4), and transmembrane (N-cadherin) markers, while negative for epithelial (E-cadherin) marker. Moreover, the cells produced abundant fibronectin, type I and type V collagen in the nearby extracellular matrix (ECM). During ex vivo cultivation of dislocated IOL-LCs in toto, the cells proliferated and likely migrated onto the IOL's anterior side. EdU proliferation assay confirmed the proliferation potential of the myofibroblasts (MFBs) in dislocated IOL-LCs. Primary cultured lens epithelial cells/MFBs isolated from the LC of dislocated IOLs could induce collagen matrix contraction and continuously proliferated, migrated, and induced ECM remodeling. Taken together, this indicates that long-lived MFBs of dislocated IOLs might contribute to the pathogenic mechanisms in late in-the-bag IOL dislocation.
| S-EPMC7689492 | biostudies-literature
Project description:Purpose:To present the case of a patient with Toric Lentis Mplus intraocular lens (IOL) (Oculentis, Berlin, Germany) opacification after vitrectomy and his follow-up. Observations:A 44-year-old man with high myopia and right optic neuritis history complained of visual impairment due to cataract in the right eye. We performed uneventful phacoemulsification and implanted a Toric Lentis Mplus IOL in his right eye. Six months later, he came to us with a retinal detachment in the nasal area of the right eye. We performed a 25-gauge vitrectomy with gas tamponade and endolaser treatment. Ten months after the vitrectomy, he complained of blurred vision in the right eye again. On slit-lamp examination, we observed a wide opacification localized to the anterior surface of the IOL. We explanted the IOL from the right eye and replaced it with a Clareon IOL (Alcon, Fort Worth, TX). The explanted IOL was examined under light microscopy and scanning electron microscopy. Conclusions and importance:We described a case of postoperative opacification of Toric Lentis Mplus IOL after vitrectomy. We found calcium aggregate deposits on the anterior surface of the IOL. Given the higher frequency of fundus disease observed in patients with high myopia, hydrophilic acrylic IOLs should be used with caution in patients with high myopia and in young patients. To our knowledge, this is the first report of Toric Lentis Mplus IOL opacification after the 2017 Field Safety Notice by Oculentis in response to the Food and Drug Administration's recall.
| S-EPMC7149404 | biostudies-literature
Project description:PURPOSE:To compare the efficacy and safety of intraocular lens (IOL) repositioning and IOL exchange for the treatment of patients with IOL dislocation. METHODS:We systematically searched for relevant publications in English or Chinese in MEDLINE, Embase, the Cochrane Central Register of Controlled Trials, WHO International Clinical Trial Registration Platform, Clinical Trial.gov, China Biology Medicine Database, China National Knowledge Infrastructure Database and grey literature sources. Study quality was assessed using the STROBE template for observational studies and the Cochrane template for randomized controlled trials (RCTs). Data were meta-analyzed using RevMan 5.3. RESULTS:The review included 14 English-language studies reporting 1 RCT and 13 retrospective case series involving 1,082 eyes. Average follow-up time was 13.7 months. Pooled analysis of 10 studies showed that the two procedures had a similarly effect on best corrected visual acuity (MD -0.00, 95%CI: -0.08 to 0.08, P = 0.99). Pooled analysis of nine studies showed no significant difference in incidence of IOL redislocation (RR 2.12, 95%CI 0.85 to 5.30, P = 0.11); pooled analysis of seven studies showed greater extent of incidence of cystoid macular edema in IOL exchange (RR 0.47, 95%CI 0.21 to 1.30, P = 0.06). Pooled analysis of three studies showed greater extent of incidence of anterior vitrectomy in IOL exchange (RR 0.11, 95%CI 0.04 to 0.33, P<0.0001). Pooled analysis of two studies showed greater postoperative spherical equivalents in IOL repositioning (MD 1.02, 95%CI 0.51 to 1.52, P<0.0001). pooled analysis suggested no significant differences between the two procedures in terms of intraocular pressure, endothelial cell density, surgically induced astigmatism, or incidence of retinal detachment, intraocular hemorrhage or pupillary block. CONCLUSION:IOL repositioning and exchange are safe and effective procedures for treating IOL dislocation. Neither procedure significantly affects best corrected visual acuity and IOL redislocation. IOL exchange was superior to repositioning in terms of postoperative SE, but IOL repositioning was associated with lower incidence of anterior vitrectomy, potentially lower incidence of cystoid macular edema.
| S-EPMC6382138 | biostudies-literature
Project description:Introduction Tetralogy of Fallot (TOF) is a congenital heart defect with characteristic features leading to unique physical exam and ultrasound findings. In settings where there is limited prenatal screening, TOF can present with cyanosis at any time from the neonatal period to adulthood depending on the degree of obstruction of the right ventricular outflow tract.1 Case Report This case describes a pediatric patient who presented with undifferentiated dyspnea and cyanosis, for whom point-of-care ultrasound (POCUS) supported the diagnosis of TOF. We highlight the important role POCUS can play in a setting with limited access to formal echocardiography or consultative pediatric cardiology services. Conclusion This report highlights the utility of POCUS as an inflection point in the diagnostic and management pathway of this patient, which is particularly important when working in a limited-resource or rural setting.
| S-EPMC9697878 | biostudies-literature
Project description:Background Spontaneous lens absorption is rare and usually occurs in eyes with certain syndromes, hyper-mature cataracts, and ocular trauma. The application of an implantable collamer lens (ICL) is widely performed in patients with high myopia for refractive correction. This study reports a case of spontaneous lens absorption after ICL implantation. Case summary A 23-year-old man was referred with complaints of poor vision in his left eye. The patient had undergone binocular ICL implantation for refractive correction of high myopia 1.5 years prior. Approximately 10 months later, he experienced a sudden loss of vision and pain in his left eye, which resolved spontaneously the next day without any treatment. Since then, the visual acuity in his left eye gradually decreased. At presentation, slit-lamp examination revealed an ICL in the posterior chamber of both eyes, with anterior capsular fibrotic proliferation and posterior capsular opacity, and the residual lens cortex sandwiched between the anterior fibrotic membrane and opacified posterior lens capsule in his left eye. The number of corneal endothelial cells in his left eye was 1,337, which was lower than before ICL implantation (2,902). The patient then underwent ICL extraction, anterior capsular capsulotomy, residual cortex aspiration, posterior capsular polishing, and intraocular lens implantation. Conclusions Spontaneous lens absorption may occur in patients with ICL implantation. Patients should undergo routine follow-ups after ICL implantation.
| S-EPMC10435081 | biostudies-literature
Project description:IntroductionPoint-of-care ultrasound (POCUS) is accepted as an important tool for evaluating patients presenting to the emergency department (ED) with dyspnea1 and undifferentiated shock.2 Identifying the etiology and type of shock is time-critical since treatments vary based on this information. Clinicians typically rely on the history, exam, and diagnostics tests to identify the etiology of shock. In resource-limited settings where there is reduced access to timely laboratory and diagnostic studies. The use of POCUS enables rapid classification and directed treatment of shock. Additionally, POCUS can aid in the diagnosis of rarer tropical diseases that can be important causes of shock in resource-limited settings.Case reportWe discuss a case of a pediatric patient who presented to an ED in Cusco, Peru, with acute dyspnea and shock. Point-of-care ultrasound was used to expedite the diagnosis of a ruptured pulmonary hydatid cyst, guide proper management of septic and anaphylactic shock, and expedite definitive surgical intervention.ConclusionIn resource-limited settings where there is reduced access to timely laboratory and diagnostic studies, the use of POCUS enables rapid classification and directed treatment of shock.
| S-EPMC8610475 | biostudies-literature
Project description:PurposeTo report a challenging intraocular lens (IOL) power calculation case who received both radial keratotomy (RK) and laser-assisted in situ keratomileusis (LASIK).ObservationsA 51-year-old man had received refractive surgery with RK and later enhanced by LASIK more than 20 years ago. He developed severe cataract in left eye with best-corrected visual acuity of 20/100. The IOL power calculation was made using several methods available at the American Society of Cataract and Refractive Surgery (ASCRS) online calculator, including IOL calculation formulas for post-LASIK condition (Shammas, Haigis-L, Barrett True K no history, and Potvin-Hill Pentacam) and formulas for post-RK condition (Double K-modified Holladay 1 based on Oculus Pentacam and IOL Master, and Barrett True K). Haigis-L, Shammas and Barrett true K no history were found to be most accurate in predicting IOL power.ConclusionsHaigis-L, Shammas and Barrett true K no history are reliable formulas for IOL power calculation in patients who received both RK and LASIK.
| S-EPMC6584476 | biostudies-literature
Project description:A 83-year-old woman underwent phacoemulsification in the left eye, complicated by posterior capsular rupture and dislocation of nuclear fragments in the vitreous cavity. She was left aphakic and referred to the Clinica Oculistica, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy. After 2 days, she underwent pars plana vitrectomy, with removal of the nuclear fragments, and secondary intraocular lens (IOL) implantation. The lens used was a sutureless scleral fixation Carlevale lens (I71 FIL SSF Carlevale lens™. Soleko IOL Division), which was delivered to the operating theatre on the morning of the operation. During the implantation, it appeared opaque, without any deposit on its surfaces. The lens was not removed. On the next day, the lens was transparent, and it remained clear at the following control visits. An in vitro experimental test demonstrated that 25% hydrophilic polymers are vulnerable to thermal shock, developing an opacification which resolves after temperature stabilization of the lens.
| S-EPMC8077362 | biostudies-literature