In this case, the IOL is falling back into the vitreous cavity and it is certainly entangled with the vitreous. This calls for a pars plana approach to remove the vitreous and bring the IOL up to the anterior segment. How would you secure this IOL? Or would you explant it and use a different type of IOL such as iris-claw IOL or anterior chamber IOL? Our guest surgeon does a beautiful job of rescuing this challenging case and giving the patient good vision.
Couple of major problems with this case. First is that the 10-0 prolene suture to fixate the IOL is inadequate….in a loop like that you are looking at failure within a few years as the lens haptic edges saw through it with micromovement. But before that happens this hydrophilic acrylic is likely to calcify and need to be removed anyway. These hydrophilic acrylic IOLs should always be removed when they dislocate in complex eyes and I’ve had to remove many that have been scleral fixated by retina surgeons (and it’s not fun). Finally closing the conjunctiva with 8-0 barbed wire or whatever was used here is going to make this poor patient miserable. Unless this patient is 95 years old it will be back to the O.R. to replace this lens within 5 years. Bank on it. Need to get the word out NOT to scleral fixate hydrophilic acrylic and to use Goretex for these cases. Sorry to be a party poop.