A 23-year-old man with traumatic subluxation, cataract, and aniridia developed a hyperopic shift following phacoemulsification and insertion of capsular tension rings with iris leaflets (aniridia CTRs) and a 1-piece acrylic intraocular lens (IOL) in the capsular bag. Early postoperative Scheimpflug imaging showed posterior bowing of the IOL in the capsular bag behind the aniridia CTR. The hyperopic shift slowly progressed up to 1 year postoperatively; at that time, Scheimpflug imaging disclosed progressive posterior IOL bowing causing a decreased effective convergent power of the IOL. After the hyperopic shift stabilized at 1 year, laser in situ keratomileusis was performed, and emmetropia was achieved after 36 months of follow-up. Our case is the first report in the literature of anterior segment imaging showing deformation of a 1-piece acrylic IOL implanted with an iris prosthesis in the capsular bag. The progressive hyperopic shift that accompanied postoperative capsule fibrosis highlights the need to use more stable IOLs when implanting aniridia CTRs.
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