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    Managing dislocated IOLs with scleral suture fixation

    Los Angeles—Scleral suture fixation of the IOL-capsular tension ring (CTR)-capsular bag complex is an effective option for surgical repositioning of a dislocated IOL, according to Robert K. Maloney, MD.

    “Considering the utility of this approach, surgeons should have a low threshold for placing a CTR during cataract surgery in eyes at risk for IOL dehiscence, such as those with pseudoexfoliation or a traumatic cataract,” said Dr. Maloney, Maloney Vision Institute, Los Angeles, and clinical professor of ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles.

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    Dr. Maloney described the technique by discussing a case of a patient he saw on referral about four years after successful phacoemulsification and IOL implantation with a CTR in the right eye. Six years prior to cataract surgery, the patient had sustained a ruptured globe secondary to blunt trauma. The rupture was repaired, but the iris that prolapsed through the rupture remained incarcerated following the surgery. The pupil was also distorted.

    The patient presented to Dr. Maloney with classic sunset syndrome, best-corrected visual acuity (BCVA) of 20/40, and complaints of blurred vision, a severe glare, and the inability to drive at night.

    Reviewing potential approaches for managing the dislocated IOL, Dr. Maloney said he ruled out an anterior chamber IOL due to the iris defect. He also decided against using the glued IOL technique after removing the CTR-capsule bag complex given the challenge of performing the latter step.

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    “Suturing around the CTR to the sclera seemed to be the natural solution, but the patient’s original surgeon was worried about suturing through the prolapsed iris, which was incarcerated in the old scleral rupture,” he said. “That was not a concern for me because my plan was to create the sclerotomies 3 mm posterior to the limbus in order to suture through the pars plana.”

    (Preop: Video 1 of 2) A classic sunset syndrome, with the edge of the optic barely visible above the pupil.  the capsule tension ring makes an arc across the pupil at the edge of the capsular bag. There is a sectoral iris defect superonasally with iris remnant visible subconjunctivally where it prolapsed through the scleral rupture. Video Courtesy of Robert K. Maloney, MD

    After removing the conjunctiva...

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