Our guest surgeon shows us his technique for suturing an IOL to the iris in a patient with long-standing peudo-exfoliation and dislocation of a three-piece IOL. We have shown a video highlighting this technique previously and there are some important learning points that we should review. The IOL should be a three-piece design, not a single-piece acrylic IOL, which would cause chaffing to the posterior surface of the iris and result in pigment loss, dispersion, and chronic inflammation. There should be at least some capsular support because supporting the entire IOL with just two iris sutures may not provide enough long-term stability. After retrieving the suture ends, a McCannel technique (shown here) or a Siepser technique (not shown in this case) can be used to cinch down the knot. Even in a perfect case with beautiful surgical technique, these sutures may not last forever. Expect about 8 to 10 years out of these sutures.
click to learn from our guest surgeon who successfully manages this tough case: