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Repositioning a dislocated IOL can be complicated but have good results
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Despite our best efforts, complications happen during cataract surgery, and often it is not surgeon error, but rather weakness or irregularity in the tissue of the patient. When cataract surgery patients do not have a sufficient degree of capsular support, alternative methods of IOL placement must be used. Placing a three-piece IOL in the ciliary sulcus is a commonly used technique that can give great long-term results and stability. Sometimes, however, the IOL can become dislodged and require a second surgery for repositioning.
Preoperative evaluation
During the slit-lamp microscope examination, the IOL position should be carefully noted, as well as the stability. When the patient shifts gaze, a loose IOL will shake or move. Also, check for IOL movement while examining the patient in a reclined position using the binocular indirect ophthalmoscope because the supine position is what you will encounter in the operating room. Retroillumination techniques allow details such as capsular defects to be seen better than direct lighting. Have the patient look in all quadrants for maximum evaluation of the retro-iris space.
Potential IOL options include a posterior chamber IOL placed in the ciliary sulcus, a posterior chamber IOL fixated to the iris or sclera or an anterior chamber IOL. Each of these options has merits and potential side effects, and studies have shown that long-term results are good with each of them. An anterior chamber IOL works well in situations in which there is no capsular support, while a sulcus posterior chamber IOL works best in cases in which there is a sufficient rim of anterior capsule. The IOL calculations for an anterior chamber IOL are done with the standard formulae using the lower A-constant of the IOL, which accounts for its more anterior position within the eye. For a sulcus posterior chamber IOL, the IOL power is calculated using the A-constant but then dropped to account for the sulcus placement.
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