ArticleAmerican journal of ophthalmology case reports2026
Intrastromal misplacement of a foldable IOL during phacoemulsification: Intraoperative OCT identification of type-1 dua's layer separation.
Article in American journal of ophthalmology case reports, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Intrastromal misplacement of a foldable intraocular lens (IOL) during cataract surgery is exceedingly rare. Immediate identification of the separation plane is critical to prevent additional corneal injury. Case report: A 76-year-old woman with bilateral glaucoma underwent routine phacoemulsification. During insertion of a one-piece acrylic IOL, the lens was inadvertently delivered into the corneal stroma. The IOL remained partially unfolded within a stromal pocket. Intraoperative anterior segment optical coherence tomography (AS-OCT; RESCAN 700) clearly demonstrated deep stromal migration of the IOL and a thick, taut, hyperreflective line consistent with a Type-1 separation of Dua's layer adherent to Descemet's membrane. This real-time confirmation enabled controlled removal of the misdirected IOL without Descemet's membrane rupture, followed by successful in-the-bag implantation of a new IOL and intracameral air tamponade. Postoperative AS-OCT showed gradual resolution of the separation without additional intervention. At 6 months, the cornea remained clear with improved visual acuity (0.6 to 0.7; logMAR 0.22 to 0.15) and an endothelial cell density of 1253 cells/mm Conclusions: Intraoperative AS-OCT provided decisive, real-time visualization of the stromal entry plane and Type-1 Dua's layer separation, allowing safe retrieval of the misdirected IOL and preservation of Descemet's membrane integrity. Recognition of this separation pattern is essential for guiding atraumatic management of this extremely rare complication.
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