Intraocular lens–induced triplopia after endothelial keratoplasty confirmed by wavefront aberrometry

Introduction: To report a rare case of symptomatic intraocular lens (IOL) dislocation presenting as triplopia after endothelial keratoplasty and to demonstrate objective confirmation using wavefront aberrometry. Patient and Clinical Findings: A 70-year-old pseudophakic woman with a complex vitreoretinal history developed visually debilitating triplopia after Descemet stripping automated endothelial keratoplasty with sulfur hexafluoride gas tamponade. Diagnosis, Intervention, and Outcomes: Examination revealed superotemporal dislocation of the IOL–capsular bag complex. Wavefront aberrometry demonstrated severe internal higher-order aberrations (HOAs), including markedly elevated trefoil, reproducing the patient's triplopia. Surgical IOL repositioning resulted in immediate symptom resolution and normalization of HOAs. Conclusions: This case highlights triplopia as a rare manifestation of subacute IOL dislocation after endothelial keratoplasty complicated by pupillary block and demonstrates the value of wavefront aberrometry in objectively correlating and monitoring patient-reported visual disturbances.