1344: dislocated IOL and capsular bag

Uday Devgan MD, , , ,

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.

This haptic has escaped from the capsular bag and is at the iris plane while the patient is seated at the slit-lamp microscope.
With retro-illumination we can see that the capsular bag is also severely compromised and the patient has a superior peripheral iridotomy.

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:

link here

Published by Uday Devgan MD

Professor Uday Devgan MD is a Los Angeles Cataract Surgeon who authors CataractCoach.com to teach the best techniques of Cataract Surgery to Eye Surgeons from around the world.