A Rare Case of Post-Traumatic Posterior Chamber Intraocular Lens Extrusion Through the Scleral Tunnel of Manual Small Incision Cataract Surgery

Traumatic posterior chamber intraocular lens (PC-IOL) extrusion via a self-sealing scleral tunnel, created for manual small-incision cataract surgery (MSICS), is a rare occurrence that has never been reported before. Usually, the PC-IOL protrudes through a ruptured cornea or falls back into the vitreous after blunt trauma. Here, we present a case of PC-IOL extrusion along the uveal tissue through the scleral tunnel in an 80-year-old woman with a history of MSICS who fell and hit her right eye on the stairs, resulting in sudden and painful loss of vision in the same eye. The IOL, along with necrotic uveal tissue, was removed from the subconjunctival space, and the ruptured scleral tunnel was sutured. After initial management, her best-corrected visual acuity (BCVA) was 6/36 with aphakic spectacle correction. The patient was advised to undergo secondary scleral fixation of the intraocular lens. The scleral tunnel made in MSICS is a potentially weak area, and the PC-IOL can come out through it. Therefore, suturing the scleral tunnel with a non-absorbable nylon 10-0 suture should be considered during MSICS. This provides additional support to the weakened scleral wall.