Intraocular lens subluxation and decompensated pseudoexfoliation glaucoma in a patient's only reading eye May consultation #1.

Abstract

An 89-year-old man had cataract surgery in 2005 in both eyes. At that time, he already had glaucoma that was well regulated with topical therapy and drusen maculopathy with incipient areal atrophy. Fifteen years later, the patient presented with a decrease in visual acuity of his only reading eye, his right eye. Visual acuity 1 year before presentation was reported as 0.5, Jg2 in his right eye, 0.2, Jg15 in his left eye with drusen maculopathy in both eyes, and an atrophic macular scar in the left eye. Slitlamp biomicroscopy showed an inferotemporally decentered and wobbling intraocular lens (IOL)-capsular bag (CB) complex in the right eye, with the bag equator and a capsular tension ring (CTR) visible in a miotic pupil and pseudoexfoliation (PXF) material accumulated along the pupillary margin. The implant specification cards showed an AcrySof MA60BM (Alcon Laboratories, Inc.) 18.50 diopters (D) 3-piece hydrophobic acrylic IOL and a 13/11 CTR (Ophtec BV). In the left eye, the IOL was well centered and stable. Intraocular pressure (IOP) was 38 mm Hg in the right eye and 13 mm Hg in the left eye with full topical therapy. The optic nerve head exhibited an estimated cup-to-disc ratio in the right eye of 0.7 with a contiguous residual rim and no excavation in the left eye. Optical biometry through the CB periphery measured an axial length of 25.50 mm. Keratometric astigmatism was 0.60 D at 45 degrees. Given that the right eye is the only eye with reading capacity and additionally experiences decompensated PXF glaucoma, what would be your surgical options and preferred approach to optically rehabilitate this patient and reduce IOL to normal levels?