Each of the double-armed straight transscleral needles (FCI Ophthalmics, Inc., Marshfield Hills, MA) can be passed through a clear corneal incision made 180º opposite to the problematic haptic. I would plan to tie the knot so that it lay buried at the base of a half-thickness scleral groove made parallel to the limbus and approximately 1.5 mm posterior to the limbus. Whether symptomatic or not, I would not want my own IOL to be left subluxated in this position. Surgical 9–0 polypropylene scleral suture fixation of the subluxated haptic would be my preferred approach if the IOL could not be successfully repositioned in the office. I would explain that a surgical suture-fixation procedure might be necessary at some future time. If the IOL remained well positioned, I would recommend against routine pupillary dilation in the future. If this were successful, I would instill topical 2% pilocarpine and ask the patient to recline for the rest of the day and return the following morning. Then, I would attempt to displace the IOL posteriorly at the slit lamp with a handheld gonioprism lens. I would use 0.5% tropicamide combined with 2.5% phenylephrine to redilate the pupil. CHANG, MDīecause the subluxation happened for the first time after the previous day’s dilation, I would make at least one more attempt to reposition the IOL in the posterior chamber. The optic and haptic of the three-piece IOL are still captured anteriorly (Figure 1) within the somewhat fibrosed capsular bag. His UCVA measures 20/25 OS, and the chamber is quiet. When the patient returns the next day, he reports no problems. Finally, you ask him to return in 24 hours, after the effect of the dilating drops wears off, and hope for self-resolution. You lay him back in the examination chair and try to massage the eye to no avail. You explain what occurred to the unsuspecting, still asymptomatic patient. Looking back at the surgical report, you read that an inferior dehiscence was noted at the conclusion of the case but stabilized after the insertion of a three-piece IOL. After pupillary dilation, he returns to the examination room, and you notice that the pupil has anteriorly captured the IOLbag complex in his left eye. He has 20/20 UCVA OU and no major complaints. How Should You Position Your Practice by 2015?Ī 59-year-old man presents for a routine yearly follow-up visit 2 years after undergoing cataract surgery on both eyes. Phaco Pearls: Methods of Ocular Anesthesia and Sedation for Cataract SurgeryĬOMPLEX CASE MANAGEMENT: Subluxated IOL After Pupillary DilationĬomplex Case Management: Refractive Enhancement 10 Years Later?Ĭurrent European Guidelines for Refractive Surgery The Role of Cataract Surgery in Glaucoma Therapy
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