Indian Journal of Clinical and Experimental Ophthalmology

Print ISSN: 2395-1443

Online ISSN: 2395-1451

CODEN : IJCEKF

Indian Journal of Clinical and Experimental Ophthalmology (IJCEO) is open access, a peer-reviewed medical journal, published quarterly, online, and in print, by the  Innovative Education and Scientific Research Foundation (IESRF) since 2015. To fulfill our aim of rapid dissemination of knowledge, we publish articles ‘Ahead of Print’ on acceptance. In addition, the journal allows free more...


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Kaur: IOL decentration post Nd-YAG laser capsulotomy


Introduction

One of the most common cause of decrease of vision in a pseudophakic patient is the formation of Posterior Capsular opacification (PCO) which is affected by several factors like the design of the implanted intraocular lens (IOL) and material of the IOL.1, 2, 3 PCO incidence has been reported to be 20.7% at 2 years & 28.5% at 5 years.4 Decrease of vision because of PCO necessitates a posterior capsulotomy with neodymium yttrium aluminum garnet (Nd-YAG) laser to create a small opening in the developed opacification. It is a commonly performed relatively safe procedure associated with rare complications like increased intraocular pressure, iritis, IOL pitting, macular edema, retinal haemorrhage, retinal detachment and endophthalmitis. Here in documenting a case of IOL decentration occurring as an acute complication post YAG-laser capsulotomy. YAG Capsulotomy leading to decrease of the visual acuity of the patient due to IOL decentration has been rarely documented in literature as a complications.

IOL decentration is calculated as the distance between the IOL centre and the reference axis (the reference axis being the pupillary axis or the visual axis).5, 6, 7 Decentration of 0.2–0.3 mm is common and clinically unnoticed for any design of IOL, larger extent decentration has a negative impact on the optical performance of the IOL and subsequently, the patients’ vision and satisfaction.8

Case Report

A 66-year old pseudophakic patient presented in OPD with complaint of decrease of vision in her right eye for two months. Her BCVA right eye was 6/12 and left eye 6/6, anterior segment was normal with presence of a foldable IOL with posterior capsular opacification in right eye. Fundus was completely normal both eyes. She was explained the need for YAG-laser capsulotomy which she underwent same day. Eye drops were prescribed and she was asked to review after one week. She presented one week later with complaint of complete loss of vision in her same eye for last two days. Knowing the complications of YAG-laser with a probability of retinal detachment (RD) in mind she was examined but to a surprise her IOL had undergone decentration, optic had moved out of centre and haptic had come in the central position causing her vision to decrease to CF counting finger at 2meter.

Figure 1

Showing decentred IOL post Yag Capsulotomy

https://s3-us-west-2.amazonaws.com/typeset-prod-media-server/612942a9-be67-4e97-9f44-6514ec950b06image1.png

Discussion

YAG-laser capsulotomy is a common procedure done routinely by all ophthalmologists in their practices. Well known complications like IOL pitting, macular oedema and RD all are aware of. In this patient a rare complication i.e IOL decentration happened five days after the procedure (highlighting that capsulotomy was done using minimal energy, was small in size, and the ophthalmologist has been doing Capsulotomies for the last many years). Reporting this since IOL decentration has not been mentioned in most of the reports of Yag Cap complications available in literature and most of the ophthalmologists might not be aware of such a surprise post YAG-laser capsulotomy. Even in a paper by Derek O’Boyle which is a large literature review of 19 studies of Yag related complications none of the 19 studies have IOL decentration as an occurrence.9

Conclusion

YAG-laser capsulotomy is an out-patient procedure done by all ophthalmologists for posterior capsular opacification. It is known to be associated with complications like macular edema, IOL pitting and retinal detachment. IOL decentration is a rare complication post YAG-laser capsulotomy and should be kept in mind specially in eyes with foldable IOL’s.

Source of Funding

None

Conflict of Interest

The authors declare that there is no conflict of interest.

References

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MW Apple School Knowledge for the Masses: World Models and National Primary Curricular Categories in the Twentieth Century. John W. Meyer , David H. Kamens , Aaron Benavot , Yua-Kyung Cha , Suk-Ying WongComp Educ Rev1993373322410.1086/447193

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AR Vasavada The work and influence of the Raghudeep Eye Clinic, Ahmedabad, IndiaExpert Rev Ophthalmol201386523510.1586/17469899.2013.847791

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SK Pandey DJ Apple L Werner AJ Maloof EJ Milverton Posterior Capsule Opacification : A Review of the Aetiopathogenesis, Experimental and Clinical Studies and Factors for PreventionIndian J Ophthalmol200452299

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M Nakazawa K Ohtsuki Apparent Accommodation in Pseudophakic Eyes after Implantation of Posterior Chamber Intraocular LensesAm J Ophthalmol1983964435810.1016/s0002-9394(14)77905-x

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A de Castro P Rosales S Marcos Tilt and decentration of intraocular lenses in vivo from Purkinje and Scheimpflug imagingJ Cataract Refractive Surg20073334182910.1016/j.jcrs.2006.10.054

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Y Nishi N Hirnschall A Crnej V Gangwani J Tabernero P Artal Reproducibility of intraocular lens decentration and tilt measurement using a clinical Purkinje meterJ Cataract Refractive Surg201036915293510.1016/j.jcrs.2010.03.043

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T Sato S Shibata M Yoshida K Hayashi Short-term Dynamics after Single- and Three-piece Acrylic Intraocular Lens Implantation: A Swept-source Anterior Segment Optical Coherence Tomography StudySci Rep201881102310.1038/s41598-018-28609-1

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J Ale Intraocular lens tilt and decentration: A concern for contemporary IOL designsNepal J Ophthalmol201136877

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D. O’Boyle C. Perez Vives S. Samavedam F. Ender J. deHaan J. Shaikh PMD1 - POST-ND:YAG Laser complications in cataract patients treated for posterior capsular opacification: a systematic literature reviewValue in Health201821Elsevier BVEurope10.1016/j.jval.2018.09.1450S243



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Article type

Case Report


Article page

157-158


Authors Details

Ruminder Kaur


Article History

Received : 17-09-2020

Accepted : 26-09-2020

Available online : 31-03-2021


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