The best placement of an iOL is in the capsular bag. That is the end of the story. There are alternate options available but they are simply not as good as in-the-bag placement for long term stability. The patient in this case had a complicated initial cataract surgery and then had the IOL sutured to the sclera using gore-tex. This suture material was placed on top of the sclera and under the conjunctiva and with time, it eroded through the conjunctiva and became exposed.
When suturing an IOL to the sclera using gore-tex, we recommend the intra-scleral suture passes as shown in this video. That prevents the issue of suture exposure and erosion. For the video showcased here, the gore-tex was placed above the sclera and just underneath the conjunctiva. This worked well initially but then with time, the gore-tex eroded through the the conjunctiva and became exposed. This video shows removal of this IOL and replacement with a three-piece IOL using the Yamane method.
The guest surgeon is Dr. Rishi Gupta who is the author of my favorite ophthalmology book called Reflections of a Pupil. You can get this book on amazon and please note that I am a big fan of the book but I receive zero compensation and zero referral fees. I have no financial interest or amazon referral link fees for this book, but I certainly wish that all of my residents (and future residents) would read this book cover to cover!
click below to learn from this complicated surgical case:
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