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VIDEO: Retrieving and re-fixating a dropped lens
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The video describes a personal method of rescuing and re-fixating an IOL that has dropped to the retina, using two quite unique surgical maneuvers.
Maneuver number 1: Lifting the IOL from the retina by aspiration. An aspiration cannula (Charles cannula) is used to grasp the optic of the IOL and lift it. Then the IOL is grasped by a V fork or endo forceps for further manipulation.
Maneuver number 2: Suturing the IOL to the lens capsule. This kind of fixation makes it possible to leave the original PMMA IOL in the eye and safely center it even in case of significant zonular defect. Suturing the IOL to the lens capsule is a delicate maneuver. To my best knowledge, it was described by Howard Gimbel and myself only.
By lifting the IOL by aspiration, you avoid the tricky maneuver of grasping the IOL with endo forceps. PMMA IOLs in particular are typically very slippery for forceps, and manipulating the forceps close to the retina carries the risk of retinal injury. Suturing the IOL to the capsule is quite possible although challenging and enabled us to perfectly center the large PMMA lens, which was already inside the eye, avoiding explantation through a necessarily large incision.
I have lifted several IOLs from the retina by aspiration and sutured them to the lens capsule in two cases. This method provided reliable long-term IOL centration.
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Pavel Stodulka, MD, PhD, an OSN Europe Edition Board Member, is chairman and CEO of the Gemini Eye Clinic, Czech Republic. He can be reached at email: stodulka@lasik.cz.