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General Ophthalmology Quiz 7
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Yichieh Shiuey, MD | Massachusetts Eye and Ear Infirmary, Harvard Medical School

December 12, 1997
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Figure 1
This is a patient who underwent phacoemulsification. The capsulotomy was performed in a "can-opener" fashion and the lens was placed within the capsular bag. There was no vitreous loss or other complication. One week after surgery the posterior chamber lens was noted to be well centered. One month after surgery the posterior chamber lens was noted to be in the position shown.
Questions and Answers
1. What is the above clinical finding?
Answer: Decentration of a posterior chamber lens producing a "sunrise syndrome"

2. What questions regarding the patient's post operative history may be helpful in ascertaining the cause of the above finding?
Answer: It is important to ask the patient if there was a history of trauma or eye rubbing, as these would be significant risk factors for decentration of the implanted lens.

3. What features of the surgery may have contributed to the above finding?
Answer: The "can-opener" capsulotomy is not as reliable as a continuous curvilinear capsulorhexis for stable intracapsular fixation of the lens. The above situation might have been avoided, if the posterior chamber lens were positioned initially in the sulcus.

4. What are possible visual complaints that this patient may have?
Answer: This patient complained of decreased vision and had a best corrected visual acuity of 20/40 with no other explanation for decreased vision other than lens decentration. Patients with decentered implants most commonly complain of (in ORDER of frequency) decreased vision, glare, monocular diplopia, streaks of light, haloes, photosensitivity, and ghost images.

5. How would you manage this patient?
Answer: If the patient is symptomatic, repositioning of the lens or lens exchange will be necessary. If asymmetric haptic fixation is the underlying cause of the decentration and capsular support is present, rotation of the lens to place both haptics in the ciliary sulcus is often sufficient. If the lens cannot be rotated INTO a good position, explantation of the lens with the placement of an anterior chamber lens or posterior chamber lens may be necessary.

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