This article is more than 5 years old. Information may no longer be current.
Surgical options for recentration of an IOL
Click Here to Manage Email Alerts
When a patient presents with a dislocated IOL, is it better to recenter the existing IOL or replace it with a new IOL? It's a trick question because it depends on the situation.
 Dislocated IOL after mild trauma. |
This patient has a history of cataract surgery performed more than 20 years ago, and he presents to you with a 1-month history of decreased vision in this eye after mild trauma (his 3-year-old grandson inadvertently hit him in the eye). You have no old records, and the photo shows the extent of the pharmacologic dilation.
In the photo, a significantly dislocated single-piece PMMA IOL is seen with haptic-optic junction near the visual axis. There is an old superior scleral incision with focal iris synechiae to the wound and to the remnants of the lens capsule. There is no central posterior capsule, and the IOL appears to be placed in the ciliary sulcus.
In this case, if the surgeon decides to replace the existing IOL, a 6-mm or larger incision will be required to remove the PMMA IOL since it is not foldable or easily cut. Because the IOL has been in the eye, functioning well and without issues for more than 20 years, it may make more sense to simply recenter this lens without removing it. And that's the approach that I took, using the Siepser technique to suture the IOL to the back of the iris to help ensure future stability.
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.