Intra-ocular lens extrusion in a patient with corneal graft melting

Abstract

Purpose: Postoperative extrusion of an intraocular lens at a site unrelated to the surgical incision is a very rare complication. We report the case of a posterior chamber intraocular lens extrusion through the cornea eight years after a penetrating keratoplasty in a patient with spontaneous aseptic stromal melting.

Observation: A 77-year-old man was treated for pseudophakic bullous keratopathy with a penetrating keratoplasty complicated by chronic graft rejection and severe glaucoma. He referred to our emergency department eight years after the surgery. The examination showed that the pseudophakic lens optic had eroded completely through the donor cornea. The globe remained intact during the extrusion process. The patient underwent excision of the pre-intraocular lens tissue, removal of intraocular lens implant and capsular bag, liberation of synechia, anterior vitrectomy and corneal graft under general anesthesia. There was no complication during or after the surgery. Histologic study suggests that the intraocular lens optic was covered by conjunctival epithelium with malpighian metaplasia.

Conclusion: To our knowledge, it's the first case of posterior chamber intraocular extrusion through ocular tissues following penetrating keratoplasty. This case emphasizes the importance of early identification of risk factors, strong postoperative follow up and good patient compliance and the need to minimize drug and surgery-induced iatrogenic effects. If the complication does ensue, early surgical intervention may prevent or minimize serious damage.

Keywords: Corneal melting; Intraocular lens; Spontaneous extrusion.

Fig. 1

Photography of the right eye. We observed an exposure of the intra-ocular lens closing the anterior segment of the eye (1A).

Fig. 2

Anterior segment optical coherence tomography of the right eye. The exam confirmed the exposure and anterior protrusion of the implant, covered by a thin tissue layer of 44 μm.

Fig. 3

Photography of the right eye just before surgery (A), during the lens extraction (B, C), and at the end of the procedure after corneal graft (D).

Fig. 4

Masson's trichrome stain histological section of the pre-IOL tissue (magnification ×10). Microscopic examination showed malpighian metaplasia of conjunctival epithelium (arrow) and connective tissue (arrow head) with fibrosis and chronic inflammation.