An 80-year-old man underwent successful bilateral cataract extraction and one-piece IOL implantation four years ago with excellent visual outcome. His ocular history is also significant for glaucoma, for which he takes bimatoprost and brimonidine/timolol.
He presents to the Emergency Department with sudden-onset painless vision loss in the right eye. There is no history of trauma, and he is systemically well with no fever, headache, or jaw claudication. His medical history is notable only for dyslipidemia, for which he takes a statin.
On examination, best-corrected visual acuity is CF in the right eye, and 20/25 in the left eye. There is no injection of the conjunctiva, corneas are clear, and the anterior chambers are deep and quiet. An intraocular lens implant is present in both eyes. In the right eye, the edge of the optic is visible within the pupil at the level of the central visual axis and the implant is tilted, with the inferior edge fallen back into the anterior vitreous. The optic nerves show no pallor or edema, the cup-to-disc ratios are 0.75 and 0.60, with inferior thinning bilaterally. The macula, vessels, and periphery are within normal limits.