This valuable teaching video was submitted by an anonymous resident who is still in training. In this surgery, a smaller phaco incision was used and then the wound-assist technique was attempted for IOL delivery. This did not work as planned and the IOL was only partially delivered into the anterior chamber. The IOL then started to expand and became stuck in the incision. What would you do next?
My advice is to first try to push the IOL into the anterior chamber. Tying forceps can be used to grasp and roll the IOL in an attempt to keep it compact and therefore slide in. If this does not work then the incision can be enlarged by using a slim blade like a side-port blade to make an entry into the anterior chamber immediately adjacent to the main incision. This can then be slightly sawed until the two incisions connect, thereby creating one larger incision.
In this case, the resident pulled the IOL out of the eye completely which took multiple tries and required sturdier instrumentation. Then the incision was enlarged and a new IOL was placed. The outcome was good and the patient achieved excellent vision.
We thank this doctor for submitting the video so that we all can learn. I encourage all of our readers to submit a video for review — and anonymous is acceptable too.
click below to learn from this unusual case of a stuck IOL: