Simple maneuvers rescue dislocated IOLs without opening anterior chamber

With two needles and a Prolene thread, the lens loop is pulled up and fixed into position.

ByMichela Cimberle

The tip is directed behind the IOL optic in order to recover the free loop from behind.

Once the needle is under the loop, the tip is directed toward the anterior chamber and pushed out at a limbal level point diametrically opposite to the opening.

At this point, a second 27-gauge insulin needle is inserted into the scleral opening, about 2 mm from the Prolene suture.

The aim is to insert the end of the first needle and the Prolene suture into the insulin needle eye.

By retracting the insulin needle, the first needle and thread, blocked inside the needle eye, will be extracted at the same time, forming a thread loop around the IOL loop.

BERGAMO, Italy — Dislodged posterior chamber IOLs can be rescued with simple maneuvers without opening the anterior chamber. Stefano Zenoni, MD, head of Bergamo Eye Clinic, devised this easy technique that only requires a needle, thread and some manual skill.

“Dislocated IOLs normally necessitates the opening of the anterior chamber and the insertion of vitreal forceps to grasp the lens loop that has sunk into the vitreous. After the injection of viscoelastic, an anterior vitrectomy is performed and the lens is fixated to the sclera,” Dr. Zenoni said.

“My technique offers the surgeon a less invasive approach. It can be performed both on non-vitrectomized and vitrectomized eyes, with no risk of anterior chamber collapse,” he said.

Pulling up the loop

A conjunctival-scleral flap is opened above the point where the IOL loop is going to be fixed. The pupil should allow a clear view of the dislocated loop in the posterior chamber.

A straight, long needle with a 10-0 Prolene suture is inserted through the scleral opening. The tip is directed behind the IOL optic in order to recover the free loop from behind (Figure 1).

“Once the needle is under the loop, the tip is directed toward the anterior chamber and pushed out at a limbal level point diametrically opposite to the opening [Figure 2]. Only one-half of the needle length should protrude. Also, make certain that the thread is kept under the IOL loop,” Dr. Zenoni said.

At this point, a second 27-gauge insulin needle is inserted into the scleral opening, about 2 mm from the Prolene suture (Figure 3). This second needle is then pushed forward toward the first needle. The aim is to insert the end of the first needle and the Prolene suture into the insulin needle eye (Figure 4).

“This is the most delicate stage of the procedure. Go gently, because in passing through the needle eye, the Prolene thread might break,” Dr. Zenoni said.

By retracting the insulin needle, the first needle and thread, blocked inside the needle eye, will be extracted at the same time, forming a thread loop around the IOL loop (Figure 5). By delicately drawing forward the two ends of the thread, the IOL can be pulled up, positioned and sutured onto the sclera.

Finally, the scleral flap and the conjunctiva can be sutured with Vicryl 8-0. This technique also can be used in case of dislocated IOLs in vitrectomized eyes preventing ocular hypotony when the anterior chamber is opened, and can be used associated with a closed vitrectomy if requested by the pathology.

For Your Information:

Stefano Zenoni, MD, is head of Bergamo Eye Clinic. He can be reached at Azienda Ospedaliera Ospedali Riuniti Di Bergamo, Largo Barozzi 1, Bergamo, Italy; +(39) 035-269287; fax: +(39) 039-2050650. Dr. Zenoni has no direct financial interest in any of the products mentioned in this article, nor is he a paid consultant for any companies mentioned.