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.
