This can be accomplished using three or four paracenteses and a 25-gauge LASIK cannula attached to a vial of dispersive OVD. Hoffman says the best approach is to viscodissect the bag open, which can be done many years after the initial surgery, and rotate the lens 90 degrees to center it. “The classic example of this is pseudoexfoliation syndrome,” says Alan Crandall, MD, senior vice-chair of Ophthalmology and Visual Sciences, and director of glaucoma and cataract at the Moran Eye Center at the University of Utah.įor a decentered IOL within an intact capsular bag, Dr. Ahmed segment with 9-0 Prolene suture being placed in the capsular bag following cataract extraction. This can occur spontaneously or as a result of trauma.įigure 2. Some IOLs are decentered but still in the bag. Videos of how to manage dislocated IOLs can be seen on Dr. Was the case uneventful or was there a posterior-capsule rupture? Finally, note which type of IOL was placed and its dioptric power,” he says. Loose zonules may have been noted during the original procedure. “Determine if the IOL was placed in the capsular bag, or perhaps in the ciliary sulcus. Uday Devgan, MD, who is in practice in Los Angeles and a professor at UCLA, notes that the operative report from the original cataract surgery can help determine whether there were complications. “Each of these can be approached using multiple techniques, so there isn’t one best technique for all scenarios,” Dr. An IOL that’s completely dislocated and is sitting on the retina.An IOL that’s in the capsular bag, and both are subluxed and decentered.The lens is in the sulcus, and that lens is decentered. A lens that’s in the sulcus, so there is a compromised capsular bag. ![]() An IOL that’s partially subluxed out of the capsular bag: One haptic is in the bag and one haptic is out, or a haptic is in and the optic and haptic are out.A lens that’s decentered within an intact capsular bag.In this article, expert surgeons share the techniques they use when faced with a dislocated lens.Īccording to Richard Hoffman, MD, who is in practice in Eugene, Oregon, IOL dislocations can be divided into five categories: However, in some cases, the IOL can become dislocated to the point where a secondary intervention is required. The IOL is placed securely in the capsular bag, and it stays there for the duration of the patient’s life. ![]() M ost cataract procedures are performed with no complications. (All images courtesy Richard Hoffman, MD.) Sunsetting three-piece IOL placed in the ciliary sulcus.
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