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Approach to the posterior dislocated IOL

ByUday Devgan, MD

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Posterior dislocated IOL.

When an IOL sunsets or becomes laterally dislocated, repositioning with suture fixation is often an appropriate step. But when an IOL is dislocated into the posterior segment, surgical repair is not so simple.

This patient underwent cataract surgery a few months ago, and upon IOL insertion there was noted to be a tear in the posterior capsule. Since this is a single-piece acrylic lens, it is meant to be implanted in the capsular bag. If a three-piece IOL had been used, the haptics could have been placed in the sulcus with optic capture through the capsulorrhexis. The surgeon elected to leave the lens in the capsular bag with the hope that the opening in the posterior capsule would not expand and that there would be enough support for long-term stability of the IOL.

After a few months of healing, the torn ends of the posterior capsule adhered to the anterior capsular rim and caused extension of the opening and loss of stability. The IOL is now displaced into the anterior vitreous, and the patient presents for surgical repair.

The challenges are:

• This single piece IOL will need to be removed but it is likely stuck in vitreous.
• Traction on the vitreous may lead to a retinal break and retinal detachment.
• The new three-piece IOL will need to be placed in the sulcus with optic capture for stability.
• The patient is at a higher risk for complications such as cystoid macular edema and even endophthalmitis.

What is your surgical approach to this case?

See Dr. Devgan share more expert insight live at Hawaiian Eye 2011, to be held January 16-21, 2011 at the Hyatt Regency Maui Resort & Spa in Ka’anapali, Maui. Learn more at OSNHawaiianEye.com.