Ashvin Agarwal, MD

This video describes the management of a subluxated single-piece rigid IOL, Soemmering ring and high IOP. To treat this, we have planned to do a trabeculectomy and refix the same IOL with a glued IOL. A vitrector is used to release the synechiae and dislodge the Soemmering ring, and then it is brought above the IOL optic so as to effectively compartmentalize the anterior and posterior chamber, thus making the scaffold ineffective and, as a result, the pieces sink into the vitreous cavity. The haptics are externalized and then tucked into the scleral pockets. Single-pass four-throw pupilloplasty is performed to avoid optic capture due to the lack of anterior capsular rim. Trabeculectomy is performed for the high IOP, and the case is closed.

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Dislocated IOLs in the posterior chamber have always been a cause of concern and a known complication after a posterior capsule rupture. Improper sulcus fixation, dislocation/subluxation of the IOL bag complex or improper judgment about the integrity of the posterior capsule intraoperatively often leads to this complicated scenario. The dislocation of an IOL not only makes the patient aphakic but can also cause complications related to the dropped IOL. Therefore, it is mandatory to explant or reposition the IOL, which in itself has its own complications and requires a major vitreoretinal intervention.

Dislocated IOLs in the posterior chamber have always been a cause of concern and a known complication after a posterior capsule rupture. Improper sulcus fixation, dislocation/subluxation of the IOL bag complex or improper judgment about the integrity of the posterior capsule intraoperatively often leads to this complicated scenario. The dislocation of an IOL not only makes the patient aphakic but can also cause complications related to the dropped IOL. Therefore, it is mandatory to explant or reposition the IOL, which in itself has its own complications and requires a major vitreoretinal intervention.