This patient had a prior cataract surgery with a single-piece acrylic IOL precariously placed into a compromised capsular bag. This was not stable and eventually the IOL dislocated into the mid-vitreous. We remove the dislocated single-piece acrylic IOL using the twist technique and then perform a thorough anterior vitrectomy via a pars plana approach.
There are multiple options for the new, replacement IOL:
- ACIOL: a properly positioned Anterior Chamber IOL can have excellent results and many studies have shown that long-term, the outcomes are similar to iris or scleral-fixated posterior chamber IOLs. While the video for a sutured PCIOL may be more fun to watch and the surgery more challenging, never underestimate the potential benefit from an ACIOL
- Iris-Claw IOL: In many countries, there are IOLs which can be attached to the iris, to either the anterior or posterior surface. In particular, the placing of an iris claw lens against the posterior surface of the iris can give great results. This lens option is not available in the USA since none have secured FDA approval.
- Scleral-fixated IOL: This option works great in cases with zero capsular support. It involves securing the IOL haptics to the scleral wall. This can be done with gore-tex for 4 point fixation, with polypropylene and 2 point fixation, with intra-scleral haptic placement (Agarwal glued-IOL and Scharrioth approach) or even IOL haptic modification (Yamane technique).
- Iris-sutured IOL: If there is some capsular support, then this option works very well and can be done with any three-piece IOL. If there is zero capsular support, this option may not give as many years of stability.
The video shown here is being performed by a senior resident who has about 200 cataracts under his belt so far. Certainly, just about any ophthalmologist should be able to learn this technique. Note that the total surgical time was prolonged, and combined with the pars plana anterior vitrectomy, more than 1 hour was required. This video has been significantly edited to be much shorter, showing just the key points.
Click below to learn the technique to suture and IOL to the iris: