Accidental complete intrastromal lens insertion during cataract surgery: management, imaging, and outcomes

Introduction: Intracorneal intraocular lens (IOL) insertion is rare complication of cataract surgery. The authors present a case of such complication, with its management and imaging. Patient and Clinical Findings: An 86-year-old woman was scheduled for routine cataract surgery. During the intervention, the IOL was inadvertently inserted into the corneal stroma because of misalignment. The patient was referred to the surgical clinic with severe eye pain and important corneal edema, with the IOL still in the cornea. Diagnosis, Intervention, and Outcomes: The IOL was extracted with toothed forceps, and the anterior chamber was bubbled, but immediate IOL implantation was deferred because of important corneal damage and decreased visibility. After 1 week, reduced corneal edema permitted successful sulcus IOL insertion. At 1 month, refraction was −1.25 × −2.50 (130 degrees) with a corrected distance visual acuity (CDVA) of 0.48 logMAR, and corneal optical coherence tomography showed a posterior stromal scar. By 3 months, refraction improved to −1.0 × −1.50 (80 degrees) with a CDVA of 0.18 logMAR, with residual stromal scarring. Conclusions: This is the first case, to the authors' knowledge, to include detailed imaging and demonstrates that early intervention can yield favorable outcomes despite extensive corneal damage. Emphasis on prevention through meticulous surgical technique is crucial. Surgeons must promptly recognize and address this complication to minimize long-term damage.