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Unilateral Intraocular Lens Implant Subluxation in an Adult

Educational Objective
Based on this clinical scenario and the accompanying image, understand how to arrive at a correct diagnosis.
1 Credit CME

A middle-aged patient with a remote history of bilateral juvenile cataracts after posterior chamber intraocular lens (PCIOL) placement presented with decreased vision in the right eye for several months. There was no recent ocular trauma or intraocular surgery. At the time of the initial examination, visual acuity was 20/50 in the right eye and 20/20 in the left eye, with a refraction of −1.50 diopters (D) sphere in both eyes. Examination was notable for a superonasal area of pigmentation with elevation of the conjunctiva and an inferotemporally subluxed PCIOL in the right eye. Results of the fundus examination were reported to be normal in both eyes and the anterior examination of the left eye was notable for only a well-positioned PCIOL. The patient was referred to a cornea specialist for further evaluation and treatment.

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A middle-aged patient with a remote history of bilateral juvenile cataracts after posterior chamber intraocular lens (PCIOL) placement presented with decreased vision in the right eye for several months. There was no recent ocular trauma or intraocular surgery. At the time of the initial examination, visual acuity was 20/50 in the right eye and 20/20 in the left eye, with a refraction of −1.50 diopters (D) sphere in both eyes. Examination was notable for a superonasal area of pigmentation with elevation of the conjunctiva and an inferotemporally subluxed PCIOL in the right eye. Results of the fundus examination were reported to be normal in both eyes and the anterior examination of the left eye was notable for only a well-positioned PCIOL. The patient was referred to a cornea specialist for further evaluation and treatment.

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Article Information

Corresponding Author: Alison H. Skalet, MD, PhD, Casey Eye Institute, Oregon Health and Science University, 3375 SW Terwilliger Blvd, Portland, OR 97239 (skalet@ohsu.edu).

Published Online: April 14, 2022. doi:10.1001/jamaophthalmol.2022.0013

Conflict of Interest Disclosures: Dr Skalet reported being a consultant for Castle Biosciences Inc. All authors were supported by grant P30 EY010572 from the National Institutes of Health and unrestricted departmental funding from Research to Prevent Blindness. No other disclosures were reported.

References
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AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

  • 1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
  • 1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
  • 1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
  • 1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
  • 1.00 credit toward the CME of the American Board of Surgery’s Continuous Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.

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