Abstract
A patient with a history of high axial myopia and prior placement of phakic iris-claw intraocular lenses years ago presented for evaluation following a recent episode of acute, painless vision loss in one eye. The patient was referred by an outside provider after experiencing spontaneous dislocation of the iris-claw lens, which had been identified on slit-lamp examination. Documentation from the referring provider indicated that a recent attempt at surgical repositioning of the dislocated lens was unsuccessful. Comprehensive ocular examination revealed no signs of corneal edema, endothelial cell loss, lens opacity, or posterior vitreous detachment. Notably, the patient demonstrated thin corneas and persistently high uncorrected myopia, consistent with long-standing axial elongation. Given the instability of the dislocated phakic IOL and the failure of attempted repositioning, the patient was counseled on the need for explantation of the current intraocular lens. A multi-step surgical plan was proposed, involving initial explantation followed by staged secondary refractive correction. Extensive discussion was undertaken regarding the available refractive options post-explantation, including refractive lens exchange (RLE), keratorefractive procedures (such as LASIK or PRK), and placement of a foldable posterior chamber implantable collamer lens (ICL). Consideration of the patient's age, refractive goals, corneal thickness, and desire to preserve accommodation ultimately led to a shared decision to proceed with implantation of a foldable ICL following lens explantation. This case underscores the long-term considerations and complications associated with phakic IOLs, the importance of individualized refractive planning in high myopes, and the evolving role of newer posterior chamber ICLs in surgical refractive correction.
Presentation Date: 05/22/2025
Issue Date: 04/17/2026
