Case 9a&b

Chief complaint
An 83-year-old female presented with gradually decreasing vision in OD since cataract surgery; positive history of falling and hitting head 3 weeks earlier.

History
Past ocular history: S/P pseudophakia OD 2 months, 1 week S/P 20/30 with chronic moderate severe dry eye OS 1998 with CME? and dry eye and decreased vision of 20/60, epithelial basement membrane dystrophy (EBMD), blepharitis, chronic open angle glaucoma (Xalatan and Alphagan P).
Past medical history: Diabetes for 15 years; hypertension, arthritis, Parkinson's disease.

Exam

Best corrected visual acuity:	20/40 OD, 20/70 OS
External:	1+ diffuse injection OU
Slit lamp:	2+ inferior keratitis OU, EBMD OU, anterior chamber clear, IOL OD IOL decentration (with dilation): Had dislocated superiorly and nasally. If don't dilate, may not see dislocation. [view video]
IOPs (applanation tonometry):	19mmHg OD, 23mmHg OS
Dilated fundus exam (DFE):	no obvious macular edema in OD; cup-to-disk ratio 0.7 OU

Assessment:

Decentered IOL secondary to trauma versus capsular fibrosis syndrome OD.

Plan/Treatment

Refer back to surgeon for repositioning of subluxated IOL.

Follow-up:

• S/P IOL exchange, IOL in sulcus
• Temporarily discontinue Xalatan OD
• Best corrected visual acuity: 20/50 OD
• IOPs (applanation tonometry): 23mmHg OD, 20mmHg OS
• Placed on Restasis bid OU for dry eye treatment

Chief complaint
A 78-year-old female presented with starbursts along with halos and monocular diplopia OD 3 weeks after cataract surgery.

History
Past ocular history: 1 week S/P 20/25.
Past medical history: Unremarkable.

Exam

Best corrected visual acuity:	20/60 OD, 20/20 OS
Slit lamp:	IOL decentration OD IOL decentration: Occurred 2-3 weeks after surgery; might not occur until later after surgery. [view video]
IOPs (applanation tonometry):	22mmHg OD, 20mmHg OS
Dilated fundus exam (DFE):	flat macula

Assessment:

Dislocated IOL with monocular diplopia and decreased vision OD.

Plan/Treatment

Referral to surgeon for IOL repositioning.