44.1.2 Dislocated IOL

Removal is not urgent; the more important question is whether the IOL can be repositioned or replaced.

Q&A

QWhat if the cataract surgeon wants to implant an IOL into an eye with a dislocated and retained IOL?

AThis is not fine. The dislocated IOL is bothersome to the patient and may cause retinal erosion with time; it also makes removal of the dislocated IOL much more difficult.

44.2Surgical Technique

44.2.1 Dropped Nucleus

•Complete the PPV, including the creation of a PVD.

•Check whether vitreous prolapse into the AC has also occurred (see Sect. 63.6).

•Determine whether the lens material can be removed with the probe (PPL). If yes, complete the procedure without using ultrasound (see Sect. 38.2.2).

•Any material too hard for the probe must be removed via phacofragmentation (see Sect. 38.3.2).

44.2.2 Dislocated IOL2

•Complete the PPV, including the creation of a PVD.

•Determine whether the IOL needs to be removed. If it can be placed in the bag or in the sulcus, follow these steps:

–Grab the superior haptic3 of the IOL with a forceps4 and bring it into the anterior vitreous. Do this with your nondominant hand.

–Remove the light pipe and insert, with your dominant hand, another forceps. Grab the distal haptic so that the forceps is underneath the optic of the lens.5

–Position the superior haptic and the optic into the AC or directly inside/over the capsular bag, then position the inferior haptic as well.

2See Sect. 38.6 if an iris-claw IOL has luxated.

3The one that is closer to 12 o’clock in the patient’s eye.

4An even better solution would be an endocryo probe, but this is not available in MIVS.

5If you have a forceps (Sunderland-type; Grieshaber, Schaffhausen, Switzerland) that can be easily rotated with your finger without you having to rotate your hand, you can directly grab the distal haptic, and turn the rotating dial 180° so that the IOL is above the forceps.