This young patient has Marfan Syndrome and previously underwent pars plana vitrectomy and lensectomy for a dislocated crystalline lens with an excellent outcome. However from time to time the patient experienced anterior prolapse of the optic with iris capture. This was resolved by putting the patient in a supine position and dilating the eye, however a more definitive solution is desired. Our innovative guest surgeon does a hashtag suture using 10-0 polyprolyene to provide a barrier to keep the IOL optic in position. What do you think?
Personally I am not a fan of this approach. For a list of reasons. IMO you want a more definitive solution….especially in a young patient. You can be sure that this will not last a life time as those prolene sutures will degrade a break. You can get iris interaction with the sutures causing PDS. This IOL is still decentered and possibly tilted and in my opinion if you are going to go into this eye, place trocars etc.do maneuvers why not fix the problem definitively and replace this lens with a well centered, well secured IOL?
If there is optic capture and the IOL is in good position without tilt, with good separation of iris from optic I’d recommend placing multiple P.I.s If that does not work a suture limiting the dilation of the iris is very effective. If the lens is too anterior or tilted it should be replaced.