# Severe astigmatism secondary to large intraocular lens pantoscopic tilt because of a malpositioned haptic following cataract surgery

## TL;DR

An 80-year-old woman developed severe astigmatism after cataract surgery due to a tilted intraocular lens, which was corrected through remedial surgery.

## Contribution

This case highlights a rare complication of IOL malposition and its successful correction.

## Key findings

- Severe IOL tilt caused by a malpositioned haptic led to significant astigmatism and visual impairment.
- Surgical correction of the haptic position improved IOL alignment and visual acuity.
- Postoperative vision was limited by pre-existing myopic macular degeneration.

## Abstract

An 80-year-old woman presented with painless blurring of vision and monocular diplopia in her left eye following routine phacoemulsification and monofocal intraocular lens (IOL) implantation 5 weeks earlier. Her uncorrected visual acuity (VA) was 6/60 correctable with pinhole to 6/21. Her best-corrected VA was 6/15 with a subjective refraction of −0.50DS/−5.25DCx37. Her corneal astigmatism was −1.25DCx74. Ophthalmic examination disclosed a severely tilted single-piece posterior chamber IOL in the capsular bag. The inferior portion of the optic was tilted posteriorly because of a twisted and malpositioned haptic. The patient underwent remedial surgery to untwist and reposition the IOL haptic which led to immediate improvement of the IOL position. Her uncorrected VA improved to 6/12−2 correctable with pinhole to 12+1 with an autorefraction of +0.25DS/−2.00DCx74 on the first postoperative day. One month postoperatively, her best-corrected VA was 6/12 with a refraction of +0.50DS/−2.50DCx82. Her final vision was limited by myopic macular degeneration.