Optic Capture of Upside Down 3-Piece Intraocular Lens to Relieve Pupillary Block : The Asia-Pacific Journal of Ophthalmology

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Optic Capture of Upside Down 3-Piece Intraocular Lens to Relieve Pupillary Block

Prasad, Priyanka MD; Batwani, Vineet Kumar MBBS; Bhayana, Amber Amar MD

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Asia-Pacific Journal of Ophthalmology 11(5):p 488, September/October 2022. | DOI: 10.1097/APO.0000000000000478
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A66-year-old otherwise healthy female was found to have a pupillary block due to an upside-down 3-piece intraocular lens (AcrySof IOL)1 captured in pupil with vision20/80, intraocular pressure 36 mm Hg (Fig. 1A). With ongoing COVID-19 lockdown and shutdown of major operation theater services and nonavailability of high-end machines/vitrector, the patient was managed by pushing down the inverted IOL and capturing optic behind the capsular openings (haptics still in sulcus). Postoperatively (Fig. 1B, C) patient had uncorrected visual acuity of 20/30 with IOP 14 mm Hg, pupillary block relieved. The ideal management should have been an IOL flip or explanting and reimplanting it in correct orientation, but we propose capturing can be a second alternative which was done in our case (being handicapped in availability of services by COVID-19 pandemic).

Figure 1:
A, Inverted 3-piece IOL in sulcus captured in pupil with pupillary block, note the S configuration of haptic denoting the IOL to be upside down. B, IOL after optic capture, note the IOL is still upside down with retained S configuration. C, Anterior segment optical coherence tomography confirming upside down IOL (posterior surface is convexer than anterior, which should be opposite, green arrows show capsular openings behind which the optic is captured). IOL indicates intraocular lens.


1. Harsum S, Low S. Reversed vaulted AcrySof intraocular lens presenting as pupillary block. Eye (Lond). 2009;23:1880–1882. doi: 10.1038/eye.2008.343.
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