Fixing a Dislocated IOL

This patient had cataract surgery done elsewhere and now seeks your help for a sub-optimal outcome in the one eye. When you examine the patient, the right eye has a well-centered single-piece toric multifocal IOL in the capsular bag, a refraction of plano, and excellent 20/20 clear vision across a wide focal range. The left eye has 20/50 vision with ghosting and a refraction of 0.00 -2.00 x180. The left eye has a three-piece multifocal IOL in the sulcus and it is significantly decentered.

Retro-illumination of the left eye shows iris-transillumination defects and a tilt to the IOL optic.

There is an opening of the posterior capsule with prolapsed vitreous which is contributing to the IOL decentration,

We perform surgery to remove the prolapsed vitreous and then re-center the IOL precisely in the visual axis. Once the patient heals sufficiently, we will then do LASIK or PRK for the residual refractive error so that we can dial in a plano outcome and give the same visual performance as the other eye.

There are so many great surgical pearls in the video, including how to do an anterior vitrectomy behind the IOL optic.

Click below to learn from this important video:

4 Comments

  1. great job on a tough case. How about a pars plana cleanup of vitreous with a vented 23 guage edge plus trocar system? The Centurion vit cutter is 23 guage and goes through it nicely. i have single packs of those available if needed on any cases

  2. What IOL-Model do you use as a 3-Piece M-IOL? I didn‘t know, that there is any now. Only as a 1-Piece…

    1. Many companies make three piece MFIOLs. Tecnis MF and ReStor MF both come in three-piece designs as well as single-piece.

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