In rare cases, years after a cataract surgery, we can have complete loss of zonular support with dislocation of the entire IOL and capsular bag complex. In dead bag syndrome, described many years ago by Dr Sam Masket (who attended me for cataract surgery > 20 years ago — an honor for me) where the capsular bag is floppy and diaphanous without proliferation of lens epithelial cells or fibrosis. There can be splitting of the capsular bag and it is so weak so instead of trying to refixate it, the better option is often to remove the entire IOL+bag, do an anterior vitrectomy, and then implant a new IOL which can be secured to the iris (iris claw lens for aphakia, not available in the USA) or to the sclera (Yamane style or Gore-tex sutured). If you have ever encountered a case of dead bag syndrome, please leave a comment below.
Ouch! That is quite an invasive technique for what is almost always quite an old patient. I prefer a simpler single suture refixation of the fibrotic capsule to the iris. Garry Condon originally described the technique, published in JCRS with his fellow Mike Siegel. The technique was published a couple years ago in David Chang’s advanced IOL fixation techniques book. I use the technique a few times a year for refixating dislocated IOL bag complexes that often have a fibrotic capsule. None have dislocated again. Recovery is quick, but caution that if due to pseudoexfoliation, glaucoma goes out of control near the time of dislocation, so I usually need to do a trab or Xen.
If the capsular bag just flakes off the IOL then it would truly be a dead bag. I’ve yet to encounter one of those, and it was not the case in this video, that bag could have still been used to save that IOL.
Thanks for the thought provoking, excellent daily videos Dr Devgan!
https://pubmed.ncbi.nlm.nih.gov/26703481/
https://eyetube.net/videos/single-suture-iris-to-capsulorhexis-fixation-for-late-in-the-bag-lens-subluxation