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Bilateral PCIOL Dislocation following Airbag Deployment

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:

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Bilateral PCIOL Dislocation following Airbag Deployment

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  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 ciliarysulcus 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 Jan;123(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 Jan;23(1):13-9. Virginia Tech-Wake Forest, Mechanical Engineering, Center for Injury Biomechanics, Blacksburg, VA 24061, USA. duma@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 CataractRefract Surg. 2004 Feb;30(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 Jun;123(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 Dec;31(12):2431-2. 7. Onwuzuruigbo CJ, Fulda GJ, Larned D, Hailstone D. “Traumatic blindness after airbag deployment: bilateral lenticular dislocation”. J Trauma. 1996 Feb;40(2):314-6. Department of Surgery, Medical Center of Delaware, Wilmington, USA.

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