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Options for fixing a dislocated lens implant
I saw a patient recently, with a history of complicated cataract surgery. He had an IOL placed in the sulcus, then a pars plana vitrectomy with silicone oil, then finally a procedure to remove the silicone oil. He was left with an inferiorly dislocated lens implant — often termed a sunsetting IOL since it looks like the sun slipping below the horizon.
The patient was symptomatic from this displaced lens which was now slipping below his visual axis. And the droplets of silicone oil on the silicone IOL didn't help things either.
What are the options for treatment?
 A sunsetting IOL which is now moving out of the visual axis and is inducing chronic inflammation in this eye. A droplet of silicone oil is noted on the anterior IOL surface. |
1. Do nothing surgically, but the patient will continue to be plagued by visual problems and the IOL may sunset further and cause iris damage.
2. Suture the existing IOL to the back of the iris for stability, but what if one of the haptics is damaged? Can the silicone droplets be completely wiped free from the IOL?
3. Remove the existing IOL and suture a new three-piece acrylic lens to the back of the iris.
I'm inclined to recommend choice 3, but the challenge in that surgery will be keeping a formed globe during the procedure. For this, I will likely choose an anterior chamber maintainer to prevent this uni-cameral eye from becoming distorted or deflated during the IOL exchange procedure. Then the Osher modification of the Siepser knot technique will be used to suture the haptics to the iris.
I'm scheduled to see the patient again in the next few weeks, at which point we'll talk more about the options and he'll make an informed decision. I'll let you know how it goes.