Lens and Cataract

East-west Decentration

East-west or horizontal decentration
  • Depends on haptics positioning and asymmetric bag-sulcus placement during surgery.
  • May develop later following eye injury, capsular or zonular disruption and contracture.

Clinical Features

  • Intra ocular lens implant is not in its normal position.
  • Symptoms: fluctuating vision, monocular diplopia, glare, halos, photosensitivity and optical aberrations
  • A sufficiently subluxated PCIOL may cause its optical zone to no longer be in pupil and leave the visual axis aphakic
  • Sunrise syndrome: Most commonly occurs due to the misplacement of the superior haptic in the ciliary sulcus, while the inferior one is placed into the capsular bag that allows the IOL to subluxate superiorly.
  • Sunset syndrome:
    • May result from undetected anterior capsule rupture extending inferiorly allowing the inferior haptic of PCIOL to escape through the defect.

Management

  • Repositioning the implant superiorly.
  • Moving the lens from the capsular bag to the sulcus.
  • Placing the optical portion in front of the iris.
  • Creating a pupillary capture.
  • Rarely it has to be removed or replaced with secondary AC IOL implantation.
  • Iris- or transcleral-sutures may be required to secure the IOL in position.
  • East-west or horizontal decentration well as posterior and anterior dislocation may also be encountered.