Temporary haptic externalization technique useful for repositioning displaced posterior chamber IOLs

A novel technique that incorporates aspects of vitreoretinal surgeries can be used to reposition dislocated posterior chamber IOLs, according to a small study. The technique involves temporarily externalizing the IOL haptics and suturing them to a corresponding sclerotomy, the authors said.

Clement K. Chan, MD, FACS, and colleagues in Palm Springs, Calif., reviewed outcomes for seven eyes of seven patients who underwent surgery to reposition a dislocated one-piece acrylic posterior chamber IOL (AcrySof, Alcon) at an average age of 67.6 years. In all cases, a capsular defect caused the IOL dislocation, according to the study.

The surgical technique used involves creating anterior sclerotomies through which the IOL haptics are temporarily externalized. Using a curved needle, the surgeon then passes 9-0 or 10-0 polypropylene sutures through the haptics' distal knobs and reintroduces the haptics into the eye for sulcus fixation.

"The needles of each double-armed suture were then passed through the margins of the corresponding anterior sclerotomy to anchor the IOL in the posterior aspect of the ciliary sulcus," the authors said.

At 17.6 months mean follow-up, all seven repositioned lenses remained centered and stable. Best corrected visual acuity improved from an average of 20/70 preoperatively to an average of 20/40 at final follow-up, the authors reported.

One eye developed mild anterior-posterior IOL tilting, but the lens remained centered and secured and the patient maintained good vision. Also in one eye, surgeons exchanged the IOL for an anterior chamber lens because of recurrent intraocular hemorrhage and cystoid macular edema, they noted.

Repositioned haptics should be sutured more than 1 mm from the limbus to avoid iris chafing, the authors added.

The study is published in the August issue of Canadian Journal of Ophthalmology.