This patient presented to our teaching clinic with a history of blunt ocular trauma about six months prior. He stated that he had “eye surgery” about a decade prior but didn’t recall much more than that. On examination at the slit-lamp microscope a single-piece acrylic IOL was noted to be dislocated along with the capsular bag. It appeared that the IOL was near the iris plane until we tilted back the exam chair and put him in a supine position. We could then easily see (using the indirect ophthalmoscope for lighting and a 20D condensing lens for magnification) that the entire IOL and capsular bag complex fell deeper into the vitreous cavity.
The resident performing this case did a great job removing this IOL and replacing it with a more secure IOL. What would be your approach? And what would you choose for the IOL and fixation technique?
click to learn from this resident case of IOL exchange: