Navigating the Options for the Treatment of Intraocular Lens Malposition.

by Dimosthenis Mantopoulos, MD, PhD; Howard F. Fine, MD MHSc; and Jonathan L. Prenner, MD There has been a wave of new and innovative techniques for vitreoretinal surgeons in the management of aphakia as well as subluxed or dislocated intraocular lenses (IOLs). Several of these techniques are quite elegant and fun to perform, but most incur a learning curve to master. Having a number of these options available is crucial to maximizing patient outcomes when presented with varying clinical scenarios. Our anterior segment colleagues are often extremely grateful for our assistance with these cases, for example when rescuing a “premium IOL” from the retinal surface. Retina surgeons also possess several advantages over our anterior segment colleagues in secondary IOL cases due to our flexibility to work in both the anterior and posterior segments of the eye. Dimosthenis Mantopoulos, MD, PhD, and Jonathan Prenner, MD, from New Jersey Retina and the Rutgers — University of Medicine and Dentistry of New Jersey provide a comprehensive overview for a number of modern IOL techniques. They highlight for what specific circumstances each technique is most useful, as well as provide surgical tips and tricks to shorten the learning curve. Lastly, I encourage readers to visit www.Healio.com/OSLIRetina, as the surgical videos provided there to accompany this article beautifully illustrate these very elegant techniques. Thanks to the introduction of smallincision phacoemulsification surgery, the safety, efficacy, and visual outcomes of cataract surgery have dramatically improved. Currently, 15 million cataract surgeries are performed globally on an annual basis.1 However, complications do occur, including postoperative intraocular lens (IOL) subluxation and dislocation. In these situations, the subsequent surgical management may become complex given the numerous variables that need to be considered to achieve an optimal result, including the type of IOL present (one-piece or three-piece), the status of the bag capsule (presence or absence of capsular support), and specifics of any particular patient’s ocular history (eg, glaucoma, corneal statue, history of trauma, visual expectations, etc.) Surgeons have recently developed a number of novel surgical techniques that, when employed in a patientspecific way, may lead to optimal outcomes. Direct comparisons of these techniques are limited in terms of evidence-based studies. This is highlighted by the American Academy of Ophthalmology Ophthalmic Technology Assessment, which found that open loop anterior chamber IOLs (ACIOLs), scleral-sutured posterior chamber IOLs (PCIOLs), and iris-fixated PCIOLs were equally safe and effective in cases of inadequate capsular support.2 Here, we review a number of the novel techniques that we employ routinely and highlight the scenarios in which we find them most useful.