Pre-Descemet's endothelial keratoplasty with glued intraocular lens implantation with pinhole pupilloplasty in a case of ocular comorbidity in achromatopsia.

Ocular comorbidities can happen as congenital defective gene associations. We present a 37-year-old female patient who was mentally challenged and had coexisting achromatopsia gene abnormality on genetic analysis. She was operated in childhood for congenital cataract, and posterior chamber intraocular lens (IOL) was implanted at 10 years of age elsewhere. The patient presented 27 years later with luxated IOL with endothelial decompensation. There was a coexisting steep and thin cornea noted on corneal topography. She was managed with pre-Descemet's endothelial keratoplasty with transpositioning of posterior chamber IOL to glued IOL with single-pass four-throw pupilloplasty. Postoperatively, the cornea was clear with centered glued IOL. The lesser postanesthetic challenges and faster rehabilitation are obtained in combination procedures with reduced complications in such rare scenarios.

Optimum pinhole size determination in pinhole pupilloplasty for higher-order aberrations.

PURPOSE: To determine optimal pinhole size (OPS) and establish a relationship with visual acuity (VA) and RMS (root mean square) values in cases with higher-order aberrations (HOAs) undergoing pinhole pupilloplasty (PPP). SETTING: Private practice, India. DESIGN: Prospective, interventional study. METHODS: RMS value for 6-mm-diameter optical zone was determined by Scheimpflug imaging (Pentacam). Patients with RMS value >0.3 µm were included. Preoperatively, a hand-held pinhole gauge with varied apertures determined the OPS, and single-pass four-throw technique was used to perform pupilloplasty with Purkinje-1 reflex as a marker for centration. VA with OPS, correlation of RMS values with OPS and pupil size, and Strehl ratio were the main outcome measures. RESULTS: 29 eyes with HOAs were analyzed; all patients chose 1.0 or 1.5 mm as OPS. The mean preoperative and postoperative pupil size was 3.25 ± 0.81 mm and 1.8 ± 0.54 mm ( P = .000), respectively. Postoperative mean pupil size when compared with OPS denoted that 14 eyes had a difference of <0.1 mm, 8 eyes ranged from 0.2 to 0.45 mm, and 7 eyes had ≥0.6 mm (range from 0.6 to 1.8 mm) difference from OPS. Eyes with higher RMS values needed smaller pupil gauge to achieve better VA. Preoperatively, vision with OPS correlated well with preoperative 6-mm RMS HOAs ( r = 0.728; P = .00). Postoperative UDVA correlated well with VA measured with OPS ( r = 0.847; P = .00). The preoperative and postoperative mean Strehl ratio was 0.109 ± 0.07 and 0.195 ± 0.11 ( P = .001), respectively. CONCLUSIONS: Higher RMS values required a smaller pupil to achieve optimum VA. PPP can help achieve pinhole size in accordance with patient's optimum pinhole requirement.

Phacoemulsification, pinhole pupilloplasty, and pre-Descemet's endothelial keratoplasty for keratoconus with Fuchs' endothelial dystrophy.

The comorbidity of keratoconus with Fuchs' endothelial dystrophy with cataract is a rare clinical combination. We present an amalgamation of surgical techniques to manage the above clinical conditions and its complications in single setting. The modified triple procedure, namely, the phacoemulsification, pinhole pupilloplasty, and pre-Descemet's endothelial keratoplasty (PDEK) in the order of description is followed in single sitting. Lens removal by phacoemulsification, correction of irregular astigmatism by pinhole pupilloplasty (pinhole optics), and exchanging the endothelial layer for PDEK forms the main segments of the triple procedure. This combination of techniques may decrease the risk of multiple surgeries and its related complications. Moreover, it will allow the patient for faster visual rehabilitation by improving the uncorrected visual acuity and visual quality.

Hypersonic vitrectomy in intraoperative posterior capsular rupture with retained nuclear fragments.

In our report, we present the hypersonic vitrectomy (Vitesse, Bausch and Lomb) being employed for anterior vitreous liquefaction and removal in posterior capsular rupture. The capsular tear with nucleus drop during conventional phacoemulsification was managed by vitrectomy using the hypersonic vitrector after posterior-assisted levitation followed by intraocular lens (IOL) implantation. The minimal cortical and epinuclear lens particles in the anterior chamber and vitreous were also liquefied with a stoke length of 30 to 40 µm and aspirated via the Vitesse vitrectomy system. The same probe performs the vitrectomy and the nucleus removal. The postoperative period was uneventful with clear cornea, normal fundus, and 20/20 best-corrected visual acuity (BCVA). The hypersonic vitrectomy utilizes the ultrasound power of 29.5 kHz and a stoke length of 0 to 60 µm for liquefaction of the vitreous. It can be a safe alternative for vitrectomy and lens removal in a single setting.

Endodiathermal Tautening of Floppy or Irregular Iris in Endothelial Keratoplasty (Iridodiathermy).

ABSTRACT: Floppy or irregular irides may be seen during endothelial keratoplasty in complex cases or in eyes with damaged irides and may cause uneven air fill, retro-pupillary air escape, anterior bowing of iris, forward movement of lens-iris diaphragm, shallowing of anterior chamber (AC), bellowing and floppiness of iris, uneven AC depth, difficulty in inserting and opening graft, iris trauma, intraoperative bleeding, and iridodialysis. We present a technique of iridodiathermy for tautening and flattening such irides. With continuous irrigation using AC maintainer, the bipolar endodiathermy probe tip is applied in localized spots to midperipheral iris in the affected area with power and duration adjusted to induce mild localized shrinkage and tightening of iris stroma. Such iris tautening decreases its floppiness and prevents anterior bowing, excessive mobility, irido-corneal touch, and peripheral anterior synechiae formation. It provides a stable AC with regular depth and improved, uniform, and nonmigratory air fill, thus decreasing intraoperative challenges.

Semilunar sign of cornea: A multimodal analysis of the posterior corneal opacity in non-infectious anterior scleritis.

Purpose: To analyze the morphological outcomes of the posterior corneal opacity or "semilunar sign" in noninfectious anterior scleritis using multimodal imaging. Methods: This was a prospective observational case series. Patients with anterior scleritis from January 2018 to January 2019 were included. Clinical and demographic data were collected. Posterior cornea was visualized using the digital slit lamp photography (Elite, mega digital vision), spectral domain optical coherence tomography (MS39), and specular count analyzer (EM-3000). "Semilunar sign" was defined by the (1) presence of posterior corneal opacity, (2) concave semilunar pattern, (3) absence of blood vessels, and (4) normal anterior cornea. Incidence, clinical characteristics and significance, correlation with Mantoux sensitivity, and role of multimodal valuation were assessed. Results: Overall 76 eyes of 72 patients were recruited with anterior scleritis. Fifteen eyes of 11 patients (15.3%) presented with semilunar sign. The scleritis was both nonnecrotizing (n = 8) and necrotizing (n = 7). The semilunar configuration appeared as isolated (n = 9) and continuous lesion (n = 6). The extent was directly related to the scleral disease extent (P = 0.002). The mean thickness measured 212.5 ± 129.3 µm. The mean central endothelial cell density (ECD) was 2540.8 ± 351.7 cells/mm2, which was significantly higher than the involved peripheral cornea (P = 0.05). The mean surface area of the semilunar sign was 7.7 ± 5.2 mm2. There was no significant correlation between the opacity thickness and the best-corrected visual acuity (P = 0.895, r = -0.39), ECD (P = 0.52, r = -0.188), and Mantoux (P = 0.696, r =- 0.142). Conclusion: Corneal semilunar sign of scleritis affected the peripheral cornea and caused no functional abnormality in early presentation. Multimodal analysis can aid in clinical assessment and severity.

Intraocular lens power calculation changes before and after isotonic collagen cross-linking in keratoconus patients.

PURPOSE: To find the intraocular lens (IOL) power calculation changes before and after isotonic collagen cross-linking (CXL) in keratoconus patients. METHODS: : Thirty-five eyes of 25 patients who underwent isotonic CXL were included. The cases included conventional CXL (n = 16), accelerated CXL (n = 7), contact lens-assisted CXL (CACXL) (n = 9), accelerated CACXL (n = 3). All underwent ocular biometry (IOL master), corneal topography (Orbscan II), and simulated keratometry (Orbscan II) preoperatively and 1-year post CXL. Change in best-corrected visual acuity (BCVA), axial length (AL), simulated keratometry (Sim K), anterior chamber depth (ACD), and IOL power were analyzed in the overall data and then grouped based on flattening (Group A) and no flattening (Group B) of Sim K value post CXL procedure. RESULTS: For the overall data, there was no significant change in IOL power (P = 0.05) at the end of 1 year, BCVA showed a significant increase (P < 0.01), and Sim K reading showed a statistically significant flattening (P = 0.001); ACD and AL showed insignificant change. In intergroup comparison, there was no statistically significant change in IOL power. However, in Group A, a significant change in BCVA and Sim K values was observed. In both groups (Group A and Group B), IOL power was found to be negatively correlated with AL and Sim K values. CONCLUSION: Isotonic CXL did not affect IOL power calculation at the end of 1 year. However, significant change in BCVA and sim K reading was noted.

Pinhole pupilloplasty after previous radial keratotomy.

The multiple radial stromal deep corneal incisions placed in radial keratotomy (RK) lead to higher-order aberrations and pose a surgical challenge to performing any further corrective procedure on the cornea because of fear of inducing an incisional dehiscence. A method to perform pinhole pupilloplasty (PPP) in the setting of previous RK is presented. Application of pinhole optics by performing PPP leads to significant improvement in image quality and helps to optimize visual potential in post-RK cases.

Glued intraocular lens in eyes with deficient capsules: retrospective analysis of long-term effects.

PURPOSE: To assess the long-term (6-12 years) results and complications of glued transscleral-fixated intraocular lens (IOL). SETTING: Dr. Agarwal's Eye Center, Chennai, India. DESIGN: Retrospective case series. METHODS: Eyes with glued IOL of more than 5-year follow-up were evaluated. Visual acuity (logarithm of the minimum angle of resolution [logMAR]), IOL tilt, corneal topography, corneal endothelial cell density, intraocular pressure, central corneal thickness, central foveal thickness, and ocular residual astigmatism (ORA) were evaluated. RESULTS: Overall, 91 eyes (63 patients) with mean postoperative 8.2 ± 2.3 years were analyzed. The duration was 10 to 12 years in 31 eyes (34%), 9 years in 14 eyes (15.3%), and 6 to 9 years in 46 eyes (50.5%). No subscleral haptic was visible in 50% eyes. Mild, moderate, and severe grade of haptic visibility was noted in 33.5%, 9.4%, and 7%, respectively. The corrected distance visual acuity (CDVA) was 0.50 ± 0.50 logMAR. Clinically, no tilt was seen in 87 eyes (95.6%), whereas detectable tilt was seen in 4 eyes (4.3%). The optical coherence tomography microtilt was 0.8 ± 1.7 and 0.4 ± 1.2 degrees in 90- and 180-degree axes, respectively. The mean iris vault was 0.45 mm, and the mean ORA was 1.10 ± 1.00 diopter. Complications were glaucoma (7.6%), IOL luxation (4.4%), retinal detachment (3.2%), macular edema (4.3%), corneal decompensation (3.2%), uveitis (2.1%), and uveitis-glaucoma-hyphema syndrome (1%). Haptic reposition (3.2%), retinal detachment surgery (3.2%) keratoplasty (1%), pupilloplasty (2.1%), and IOL explantation (1%) were the second surgeries performed. CONCLUSIONS: Glued IOL has shown good anatomical and functional stability with minimal incidence of vision-threatening complications on long-term.

Pinhole Pupilloplasty for Higher Order Aberrations: Assessment of Visual Quality and Depth of Focus.

PURPOSE: To evaluate visual quality and depth of focus under photopic and mesopic light conditions of patients treated with pinhole pupilloplasty (PPP) for corneal higher order aberrations. METHODS: This was a prospective, noncomparative, interventional series and PPP was performed with a single-pass four-throw procedure in 14 eyes of 14 patients. After PPP, patients were analyzed with the Clinical Trial Suite machine (M & S Technologies, Inc) that offers a standardized method of recording visual quality. The luminance levels of 85 and 3 cd/m2 were set for photopic and mesopic lighting conditions, respectively, and uncorrected and corrected distance visual acuity were recorded for distance (4 m), intermediate (66 cm), and near (44 cm). Low contrast acuity (LCA) at 10% and mesopic contrast sensitivity function (CSF) with glare on and off at four spatial frequencies of 1.5, 3, 6, and 12 cycles per degree (cpd) and defocus curve were assessed. RESULTS: Under photopic and mesopic conditions, a significant difference was observed postoperatively in uncorrected and corrected distance visual acuity for distance, intermediate, and near. The defocus curve demonstrated extended depth of focus that ranged from +1.50 to -2.50 diopters and LCA at 10% demonstrated significant improvement for all cases. For mesopic CSF, a significant improvement was noted at spatial frequencies of 3 and 6 cpd with glare on. With glare off, an improvement was seen at spatial frequencies of 1.5, 3, and 6 cpd, but not at 12 cpd. CONCLUSIONS: Early results demonstrate that PPP provides improved visual quality and extended depth of focus and can be a useful option in cases with higher order aberrations. [J Refract Surg. 2020;36(12):812-819.].

Persistent asymptomatic vitreous cyst with ten years follow-up: A case report.

Asymptomatic free floating vitreous cyst with macular coloboma constantly been stable for 10 years is a rarely reported case. Here, we report a case of 30-year-old male who presented to us with best corrected visual acuity of 6/12 and 6/18 in right and left eye, respectively. On slit-lamp examination anterior segment was normal. His fundus examination showed a solitary free floating cyst in the vitreous in right eye and bilateral macular coloboma. Blood tests for toxoplasmosis and cysticercosis were negative. The patient had no symptoms, so we decided to follow the patient without any treatment.

Densitometry Analysis of Corneal Backscatter After Pre-Descemet Endothelial Keratoplasty for Pseudophakic Bullous Keratopathy.

PURPOSE: To quantify corneal backscattering by densitometry analysis after pre-Descemet endothelial keratoplasty (PDEK). DESIGN: This is a prospective observational case series. METHODS: Setting: Tertiary care hospital. PARTICIPANTS: Postoperative PDEK eyes with best-corrected visual acuity (BCVA) ≥20/40 without comorbidity. OBSERVATION PROCEDURE: Slit-lamp examination, Scheimpflug imaging (Pentacam; Oculus, Wetzlar, Germany), endothelial cell density (cells/mm), and central corneal thickness (Visante; Carl Zeiss AG, Oberkochen, Germany) were performed. Corneal densitometry values for the entire depth of the cornea were compared between post-PDEK eyes and fellow eyes (non-PDEK). MAIN OUTCOME MEASURES: Mean densitometry (grayscale units, GSUs) of the anterior, posterior, central, total depth and concentric zones (0-2, 2-6, 6-10, and 10-12 mm) of the cornea. RESULTS: Overall, 35 eyes (21 PDEK eyes and 14 control eyes) were evaluated. The mean total densitometry values in the anterior, central, and posterior corneas were 40.7 ± 7.6 GSU, 25.3 ± 4.8 GSU, and 20.9 ± 3.4 GSU, respectively. On inter-zone comparison between central and peripheral cornea, there was a statistically significant difference (P < 0.05) between 0 to 2 mm and 6 to 12 mm zones. There was no correlation between endothelial cell density and central corneal thickness with densitometry. However, there was a significant correlation of BCVA with corneal densitometry in 0 to 2 mm (r = 0.519, P = 0.016) and 6 to 2 mm (r = 0.556, P = 0.009) zones. In eyes with BCVA 20/20, there was no significant difference between PDEK and control eyes in the total corneal densitometry in the entire depth of the cornea (P = 0.662). CONCLUSIONS: Clinically clear corneas with visual acuity 20/20 showed no difference in the total corneal densitometry as compared to their fellow eye. Corneal backscatter was higher in the anterior cornea and in the central 0 to 6 mm zone.

Uveitis and deficient lens capsules: Effect of glued intraocular lens on the visual outcome and the reactivation of inflammation.

Purpose: To evaluate the visual outcome and complication profile after glued intraocular lens (IOL) in post uveitic eyes. Methods: Patients with history of uveitis who had glued IOL with 3 months antecedent quiet anterior chamber (AC) were included in this prospective observational case series. Visual acuity, slit-lamp examination, fundus evaluation, optical coherence tomography, intraocular pressure, specular count and AC inflammation were analyzed before and after glued IOL procedure. Glued IOL eyes were also compared with their fellow normal capsular bag IOL. Results: Overall 17 eyes (50.7 ± 16.1 years) were analyzed. It included 41.8%, 23.5%, and 35.29% anterior, posterior, and pan uveitis, respectively. The etiologies were tuberculosis (23.53%), toxoplasmosis (11.77%), Fuch's heterochromic cyclitis (5.88%), HLA B27 (11.77%), psoriatic arthritis (5.88%), Rheumatoid arthritis (5.8%), sarcoidosis (11.77%), herpetic kerato-uveitis (5.88%), and idiopathic (17.65%). Cataractous subluxated lens (35.3%), aphakia (23.5%), decentered IOL (23.5%) and intraoperative capsular rupture (17.6%) were the surgical indications. A significant improvement in the mean uncorrected and best corrected visual acuity (P < 0.001) was recorded. The complications were IOL pigment dispersion (47%), macular edema (41%), and epiretinal membrane (24%). There was significant rise in AC reaction on day 1 (P < 0.001) and normal AC was attained by 88.2% eyes at 6 months. AC inflammation reactivation was noted in 11.7% of eyes. Though inflammatory reactivation was similar to the normal IOL, macular edema was higher in glued IOL. Conclusion: Glued IOL can cause inflammation in uveitis eyes which can be managed medically with minimal complications.

Application of Purkinje images for pinhole pupilloplasty and relevance to chord length mu.

PURPOSE: To evaluate the results of pinhole pupilloplasty in cases with high astigmatism and higher-order aberrations (HOAs). SETTING: Dr. Agarwal's Eye Hospital & Research Centre, Chennai. DESIGN: Case series. METHODS: Pinhole pupilloplasty was performed based on the Purkinje 1 (P1) images formed from the light source of a Lumera surgical microscope; the images served as a reference marker for centration. A single-pass 4-throw technique was used to achieve a pinhole pupil. The preoperative and postoperative pupil diameter, uncorrected (UDVA) and corrected (CDVA) distance visual acuities, simulated keratometry (K), and chord length mu (µ) were assessed, the latter using a Pentacam rotating Scheimpflug camera. RESULTS: Pinhole pupilloplasty was performed in 8 eyes (8 patients). There was a statistically significant reduction in the mean horizontal and vertical pupil diameters and in the mean pupil diameter from preoperatively to postoperatively (both P < .001). Although the improvement in UDVA was statistically significant (P < .001), the change in CDVA was not. The mean simulated K and mean chord length µ values were significantly lower postoperatively (P = .024 and P < .001, respectively). The reduction in pupil size was more apparent than the reduction in chord length µ. The correlation between the change in chord length µ and the change in pupil size was not significant (r = -0.067, P = .874). The pupil was well centered on the P1 images. No major adverse events or complications occurred postoperatively. CONCLUSION: Postoperative results showed a correlation between the improvement in visual acuity and the decrease in pupil size and chord length µ.

Epiretinal membrane profile on spectral domain optical coherence tomography in patients with uveitis.

PURPOSE: To study the epiretinal membrane (ERM) profile on the spectral-domain optical coherence tomography (SDOCT) in eyes with uveitis. METHODS: In this prospective observational study, macula of uveitic eyes were evaluated by SDOCT (Cirrus, model 5000) for ERM. ERM was quantified (in microns) and were followed up along with the best-corrected visual acuity (BCVA) and treatment profile for 1 year. ERM morphology (focal, global, or mixed) and characteristics (thickness at fovea, maximum thickness, and location of maximum thickness in relation to fovea) were documented. Changes in altered foveal contour, cystoid macular edema (CME), and central foveal thickness were also noted. BCVA was noted when the inflammation subsided and it was correlated to specific ERM characteristics. SDOCT characteristics were compared in three treatment groups (no oral steroids, oral steroids with, and without immunomodulators). RESULTS: Thirty-four eyes of 25 patients were evaluated. Mean logMAR BCVA decreased from 0.25 to 0.35 (P = 0.005). Foveal involvement with ERM (P = 0.011), lost foveal contour (P = 0.043), and ellipsoid layer disruption (P = 0.017) were associated significantly with reduced BCVA. Focal attachment of ERM was more commonly associated with CME (P = 0.03). Median ERM thickness showed significant increase (P < 0.001). Significant ERM progression from parafoveal to foveal (P = 0.02), significant progression of the thickest area of ERM closer to fovea (P = 0.0006) indicated a strong tendency of foveal involvement and this was correlated with worse BCVA (P = 0.009, r = -0.44) Oral steroids/immunomodulators showed no significant benefit on ERM progression. CONCLUSION: ERM progression in uveitis has a tendency to involve the fovea and is associated with significant vision loss, particularly in foveal ERM, focal attachment, and IS-OS disruption. Oral steroids and immunomodulators have no role in halting progression.

Iris and knot configuration after Single Pass Four Throw (SFT) pupilloplasty as imaged by the spectral-domain optical coherence tomography.

PURPOSE: To analyze the morphological changes in the iris-knot complex configuration using spectral-domain optical coherence tomography (SD-OCT) following the single pass four throw (SFT) pupilloplasty. METHODS: In this retrospective case series, eyes with SFT pupilloplasty were examined by SD-OCT (Optovue). Iris morphology compared to the normal iris, presence of specific patterns (single hump, double humps, peaks and valleys, tethering), prolene suture, knot complex (length and orientation), and intraocular lens (IOL) vault were evaluated. RESULTS: Overall, 41 knots of 26 patients with a mean time duration of 3.1 ± 2 months from surgery were analyzed. Iris configurations seen were single hump (n = 28, 63.8%), double humps (n = 7, 17%), loop (n = 2, 4.8%), flat (n = 3, 7.3%), and mulberry (n = 1, 2.4%). The mean length and the height of the knot complex was 784.1 ± 433.7 µm and 317.7 ± 110.4 µm, respectively. Knot positions were at 3 clock hours in 9 eyes (21.9%), 9 in 8 eyes (19.5%), and others in 24 eyes (58.5%). Cut end of the prolene suture was detectable in 26 eyes (63.4%) as hyper-reflective line, and the mean cut length was 465.8 ± 321.1 µm. The suture was predominantly vertically oriented (80.6%) to the iris with a mean distance of 3.6 ± 0.3 mm (2.6-4 mm) away from corneal endothelium. The mean distance from the knot complex and the IOL was 289.2 ± 146 µm and the mean anterior chamber depth was 4.1 ± 0.1 mm. CONCLUSION: A significant change in iris configuration was noted after SFT pupilloplasty, and vertically oriented retained prolene suture was predominant with good endothelial vault.

"Mouse Sign" on Optical Coherence Tomography of Detached Endothelial Graft Indicates Graft Inversion.

PURPOSE: To report the mouse-like configuration of detached endothelial keratoplasty graft observed on optical coherence tomographic imaging after pre-Descemet's endothelial keratoplasty (PDEK). CASE REPORT: Three eyes of 3 patients who underwent PDEK and had graft detachment in the initial postoperative period of <2 weeks were examined. Fourier domain optical coherence tomography was performed in all eyes. All 3 patients had partial graft detachment with the detached region involving the central and inferior cornea. One end of the graft formed a thick convex scroll detaching outward, downward, and upward, and the other end was attached to the edematous cornea forming the 'mouse' configuration. The graft was inverted, and rebubbling failed in all 3 eyes. Graft exchange was required. CONCLUSION: Mouse sign in OCT imaging indicates the possibility of an inverted graft and predicts unsuccessful rebubbling. Graft exchange is required in such eyes.

Twenty-five-gauge trocar anterior chamber maintainer: New device for infusion.

The technique, feasibility, and results of a new 25-gauge trocar-anterior chamber maintainer (ACM) designed for maintaining intraoperative fluid infusion is described in this prospective interventional analysis. The 25-gauge trocar-ACM with an overall length of the trocar blade of 6.0 mm, cannula length of 4.0 mm, and the cannula tip beveled at 45 degrees to the base was designed and used in all the cases. The dimensions of the sclerotomy wound that comprised of the internal ostium, external ostium, wound length, and the time interval for wound apposition in the postoperative period was analyzed by spectral-domain anterior segment optical coherence tomography.

Extended focal length intraocular lens implantation in posttraumatic posterior capsular rupture.

We present a case of posterior capsular defect with traumatic cataract after blunt trauma in which an extended focal length intraocular lens (IOL) was implanted in the bag after conventional phacoemulsification and anterior vitrectomy. Anterior segment optical coherence tomography performed preoperatively aided in the confirmation and documentation of the capsular integrity. Intraoperative trocar anterior chamber (AC) maintainer allowed AC maintenance without further complications. IOL was well centered postoperatively at 6 months, and the unaided visual acuity was 20/20 for distance and N8 for near. The report showed that an extended depth of focus IOL can be placed in eyes with ruptured posterior capsule for good visual outcome in posttraumatic young eyes and it may not be considered as a relative contraindication for it.