Bilateral PCIOL Dislocation following Airbag Deployment

1
Bilateral PCIOL Dislocation following Airbag
Deployment

• Authors
• Evan Lagouros MD, Lawrence Lohman MD FACS
• Department of Ophthalmology
• SUMMA Health Systems
• Northeast Ohio Universities College of Medicine
• Financial Disclosures
• The authors have no financial interest in the
  subject matter of this e-poster

2
Case HPI

• 88 year-old female presented after automobile
  accident at unknown speed, in which airbag
  deployment occurred.
• Her previous ocular history is significant for
  pseudophakia with PCIOL OU with both implants
  well positioned
• Immediately after the accident, she complained of
  decreased vision OU and sensitivity to light. Her
  pre-accident BCVA was 20/40 OD, 20/30 OS.
• Post accident she was count fingers in both eyes
  with a potential acuity meter of 20/70, 20/60 OD
  and OS respectively.

3
Exam

• Initial imaging revealed a small, non-displaced
  nasal bone fracture without any other signs of
  ocular trauma.
• Initial exam revealed bilateral traumatic iritis,
  irregular pupils OU, and bilateral lens
  dislocation. Intraocular pressure was 24 (mmhg)
  OU.

4
OD One haptic of the IOL had dislocated in front
of the iris with iris capture nasally, and the
other haptic remained in the posterior chamber,
but likely not still in the capsule
5
OS IOL displaced superiorly with one haptic
crossing the pupil border inferiorly. There was
also instability/movement of the IOL,
Contraction of the anterior capsule, and zonular
weakness without obvious zonular dehiscence
6
Additional Findings

• With treatment her iritis resolved, however she
  developed ocular hypertension, which was treated
  medically.
• Planned for surgical repair of bilateral
  dislocation

7
Surgical Repair

• The left eye was operated on first, due to the
  contraction and instability of the bag. Lens
  removal with ciliary sulcus sutured lens
  placement and anterior vitrectomy was performed.
• Shortly after, the same procedure was performed
  OD
• Post operative BCVA was 20/40 OU. At last visit,
  the patient was still continuing IOP lower agents
  OU, and had been weaned off all other post-op
  drops.

8
Post-Operative OD
9
Post-Operative OS
10
Discussion and Literature Review

• Air bags have become a standard feature on
  automobiles over the last 10 to 15 years.
• Despite the countless severe injuries prevented
  by their use, air bag deployment is the most
  common cause of ocular injury in motor vehicle
  accidents(MVAs)1.
• Air bags have been associated with a two fold
  increase in eye injuries1
• Lens dislocation following air bag deployment is
  rarely reported 1,3,6,7. Only 1 report of
  bilateral dislocation was discovered by the
  author 7. It is unclear if this case was an
  artificial lens or a crystalline lens.

11
Surgical Options and Prevention

• Surgical management the authors would recommend
  an individualized approach on a case by case
  basis.
• However, as with other causes of traumatic
  dislocation, bag integrity is often compromised
  somewhat limiting surgical options.
• Most importantly, the patient should be educated
  regarding, the possible need for multiple
  surgeries, and possible limits of best corrected
  visual acuity despite surgical correction.
• Wearing a safety belt resulted in a two-fold
  decrease in risk of ocular trauma during MVAs 1.
  

12
Thanks

• References
•  
• 1. McGwin G Jr, Owsley C. Risk factors for
  motor vehicle collision-related eye injuries.
  Arch Ophthalmol. 2005 Jan123(1)89-95.
  Department of Epidemiology and International
  Health, School of Public Health, University of
  Alabama at Birmingham, USA.
• 2. Duma SM, Rath AL, Jernigan MV, Stitzel JD,
  Herring IP. The effects of depowered airbags on
  eye injuries in frontal automobile crashes. Am J
  Emerg Med. 2005 Jan23(1)13-9. Virginia
  Tech-Wake Forest, Mechanical Engineering, Center
  for Injury Biomechanics, Blacksburg, VA 24061,
  USA. duma_at_vt.edu.
• 3. Ball DC, Bouchard CS. Ocular Morbidity
  Associated with Airbag Deployment. Cornea 20(2)
  159-163, 2001.
• 4. Uchio E, Kadonosono K, Matsuoka Y, Goto S.
  Simulation of air-bag impact on an eye with
  transsclerally fixated posterior chamber
  intraocular lens using finite element analysis.
  J Cataract Refract Surg. 2004 Feb30(2)483-90.
• 5. Stitzel JD, Hansen GA, Herring IP, Duma SM.
  Blunt trauma of the aging eye injury mechanisms
  and increasing lens stiffness. Arch Ophthalmol.
  2005 Jun123(6)789-94. Virginia Tech--Wake
  Forest Center for Injury Biomechanics,
  Winston-Salem, NC, USA.
• 6. Blackmon SM, Fekrat S, Setlik DE, Afshari NA.
  Posterior dislocation of a crystalline lens
  associated with airbag deployment. J Cataract
  Refract Surg. 2005 Dec31(12)2431-2.
• 7. Onwuzuruigbo CJ, Fulda GJ, Larned D,
  Hailstone D. Traumatic blindness after airbag
  deployment bilateral lenticular dislocation. J
  Trauma. 1996 Feb40(2)314-6. Department of
  Surgery, Medical Center of Delaware, Wilmington,
  USA.