title: Anterior haptic flexing and in-the-bag subluxation of an accommodating intraocular lens due to excessive capsular bag contraction.
abstract: We describe the case of a patient who had cataract surgery with implantation of the hydrophilic acrylic Tetraflex accommodating intraocular lens (IOL), with subsequent development of capsulorhexis phimosis and in-the-bag IOL subluxation. Contraction of the capsular bag secondary to fibrosis resulted in significant anterior flexing of the lens haptic component. Explantation of the IOL-capsular bag complex was required 7 years after implantation. Histopathologic analysis demonstrated multiple areas of thick anterior subcapsular fibrosis. Pseudoexfoliative material was present throughout the surface of the lens capsule. Intraocular lenses manufactured from hydrophilic acrylic material are highly flexible and may be more susceptible to capsule contraction, even in the absence of predisposing ocular and systemic conditions. This case highlights the importance of developing guidelines regarding patient screening and selection for the appropriate use of accommodating and other highly flexible IOLs.
  
  
  BACKGROUND
  No author has a financial or proprietary interest in any material or method mentioned.
authors.affiliation: From the John A. Moran Eye Center (Kramer, Werner, Mamalis), University of Utah, Salt Lake City, Utah, USA; Augenklinik am Marienplatz (Neuhann), Munich, and Berlin Eye Research Institute (Tetz), Berlin, Germany.
authors.forename: Gregory D
authors.initials: GD
authors.lastname: Kramer
authors.affiliation: From the John A. Moran Eye Center (Kramer, Werner, Mamalis), University of Utah, Salt Lake City, Utah, USA; Augenklinik am Marienplatz (Neuhann), Munich, and Berlin Eye Research Institute (Tetz), Berlin, Germany. Electronic address: liliana.werner@hsc.utah.edu.
authors.forename: Liliana
authors.initials: L
authors.lastname: Werner
authors.affiliation: From the John A. Moran Eye Center (Kramer, Werner, Mamalis), University of Utah, Salt Lake City, Utah, USA; Augenklinik am Marienplatz (Neuhann), Munich, and Berlin Eye Research Institute (Tetz), Berlin, Germany.
authors.forename: Tobias
authors.initials: T
authors.lastname: Neuhann
authors.affiliation: From the John A. Moran Eye Center (Kramer, Werner, Mamalis), University of Utah, Salt Lake City, Utah, USA; Augenklinik am Marienplatz (Neuhann), Munich, and Berlin Eye Research Institute (Tetz), Berlin, Germany.
authors.forename: Manfred
authors.initials: M
authors.lastname: Tetz
authors.affiliation: From the John A. Moran Eye Center (Kramer, Werner, Mamalis), University of Utah, Salt Lake City, Utah, USA; Augenklinik am Marienplatz (Neuhann), Munich, and Berlin Eye Research Institute (Tetz), Berlin, Germany.
authors.forename: Nick
authors.initials: N
authors.lastname: Mamalis
mesh_terms: D000065:Accommodation, Ocular / Q000502:physiology; D000368:Aged; D060437:Artificial Lens Implant Migration / Q000175:diagnosis / Q000209:etiology*; D019923:Capsulorhexis; D003286:Contracture / Q000150:complications*; D020878:Device Removal; D005260:Female; D005355:Fibrosis; D006801:Humans; D007903:Lens Capsule, Crystalline / Q000473:pathology*; D019654:Lens Implantation, Intraocular; D007910:Lenses, Intraocular; D018918:Phacoemulsification; D011474:Prosthesis Design