Decentration of a toric intraocular lens implant in a patient with simple megalocornea

PURPOSE: To describe a patient who developed radial displacement of the capsular bag and toric intraocular lens implant within approximately 5 weeks after surgery. OBSERVATIONS: A patient underwent uncomplicated cataract extraction and implantation of a toric IOL for 2.5 diopters (D) of preoperative corneal astigmatism. Uncorrected visual acuity (UCVA) on postoperative day 1 was 20/20. Blurriness developed 5 weeks after surgery when UCVA was 20/70 but corrected to 20/20 with 2 D of cylinder in a new axis. The IOL was in the proper axis, but it and the capsular bag were radially displaced. Dilated examination revealed posterior capsular opacification superotemporally, outside the visual axis. The patient's biometry revealed axial myopia and megalocornea (white-to-white measurement of 13.44 mm), suggesting a larger than average capsular bag. Surgery was performed at postoperative week 6 to expand the capsular bag using a capsular tension ring and to re-center the IOL keeping the same axis. The patient recovered UCVA of 20/25 after the IOL was recentered. CONCLUSIONS AND IMPORTANCE: It is important to review biometry for large white-to-white measurements. Eyes with megalocornea may require capsular tension rings at time of toric IOL implantation so as to maintain IOL centration and good UCVA.