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Iris capture by the IOL optic
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 Iris capture by the IOL optic. |
A patient presents a week after cataract surgery at the UCLA resident ophthalmology clinic with a complaint of pain in the eye of sudden onset. At the slit lamp, the optic is prolapsed through the pupil and overriding the inferior half of the iris.
The patient's original cataract surgery was complicated by posterior capsule rupture and vitreous loss, and a three-piece acrylic lens was placed into the ciliary sulcus. Now the patient has iris capture by the IOL optic, a myopic shift from the anterior displacement of the lens, and induced astigmatism from the tilt of the optic.
When the capsule ruptures, placement of the IOL becomes more challenging. In cases of a small posterior capsule defect, the IOL may still be placed in the capsular bag. Alternatively, the IOL haptics may be placed into the ciliary sulcus if it is a three-piece design, with multiple options available for the optic: The optic can be left in the sulcus (like in this patient), it can be captured behind the anterior capsulorrhexis, or it can be captured behind a posterior capsulorrhexis.
If the optic is left in the sulcus, care should be taken to use a posterior vaulted IOL in which the optic is angulated approximately 10° behind the haptics. In this case, a planar IOL was used, and we have iris capture of the optic.
What do you do to help this patient?
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