case_images: PMC4742651_01
case_images: The preloaded intraocular lens (Hoya iSert PS AF-1 [UV], PC-60AD; Hoya, Tokyo, Japan) and intraoperative clinical photographs. (A) The whole instrument. (B) Removal of the remnants of both the epinucleus and cortex. (C) Pushing the plunger forward. (D) Inserting the intraocular lens (IOL). (E) The unfolded IOL. (F) Optic fracture of the IOL. (G) Widening the corneal incision. (H) Withdrawing the IOL. (I) Fixation within the sulcus, and completion of the surgery.
case_images: kjo-30-79-g001.jpg
case_images: PMC4742651_01_kjo-30-79-g001.jpg
case_images: F1
case_images: For IOL insertion, we prepared a preloaded, three-piece IOL (Hoya iSert PS AF-1 [UV], PC-60AD; Hoya, Tokyo, Japan) (Fig. 1A) after removal of the remnants of both the epinucleus and cortex (Fig. 1B). We gently pushed the plunger forward and slowly rotated the iSert system clockwise in order to engage the threads and allow insertion of the IOL (Fig. 1C and 1D). Upon investigation, we found that the IOL optic had unfolded and broken into two pieces, with small posterior capsule rupture (Fig. 1E and 1F). We widened the corneal incision and withdrew the IOL from the chamber (Fig. 1G and 1H). After ensuring that there had been no loss of vitreous, a three-piece IOL was fixed inside the ciliary sulcus, and we successfully completed the cataract surgery (Fig. 1I).