Optic Fracture of the Preloaded Intraocular Lens during Insertion

Dear Editor, Intraocular lens (IOL) fracture is a relatively rare complication of cataract surgery during IOL implantation [1]. Foldable IOLs specifically are often fractured by either forceps or injector systems during IOL loading [2,3]. To improve the efficacy and safety of cataract surgery, many preloaded IOLs have been developed and are widely used. Here, we report the first optic fracture in a preloaded IOL during posterior chamber, hydrophobic, acrylic IOL insertion. A 75-year-old male patient was admitted for left eye cataract surgery. He had no recent systemic disease and no history of ocular trauma. During surgery, the lens nucleus was successfully removed. For IOL insertion, we prepared a preloaded, three-piece IOL (Hoya iSert PS AF-1 [UV], PC-60AD; Hoya, Tokyo, Japan) (Fig. 1A) after removal of the remnants of both the epinucleus and cortex (Fig. 1B). We lubricated the iSert system inside (Hoya) case. We firmly grasped the body and slowly inserted the system in one continuous motion using the slider. We gently pushed the plunger forward and slowly rotated the iSert system clockwise in order to engage the threads and allow insertion of the IOL (Fig. 1C and 1D). However, during IOL insertion, we heard a cracking sound. Upon investigation, we found that the IOL optic had unfolded and broken into two pieces, with small posterior capsule rupture (Fig. 1E and 1F). We widened the corneal incision and withdrew the IOL from the chamber (Fig. 1G and 1H). After ensuring that there had been no loss of vitreous, a three-piece IOL was fixed inside the ciliary sulcus, and we successfully completed the cataract surgery (Fig. 1I). There were no further postoperative complications in the 3 months following surgery. Our case is unique due to optic fracture of the preloaded IOL during IOL insertion. The IOL was a three-piece lens with a 6.0-mm hydrophobic acrylic optic and polymethyl methacrylate chemically bonded haptics. The overall diKorean J Ophthalmol 2016;30(1):79-80 http://dx.doi.org/10.3341/kjo.2016.30.1.79