A Modified Iris Suture Technique for In-the-bag Intraocular Lens Dislocation

A Modified Iris Suture Technique for In-the-bag Intraocular Lens Dislocation Clinically significant posterior chamber intraocular lens (PCIOL) decentrations or dislocations occur in the aftermath of approximately 2% to 3% of cataract surgeries. Early inor out-of-the-bag intraocular lens (IOL) dislocations arise within 3 months of surgery, primarily as a result of traumatic zonular or capsular rupture, respectively. Recently, increasing attention has been focused on late in-the-bag IOL dislocations, which occur more frequently than previously recognized (in 0.1–1.7% of cases), and result from zonular incompetence and dehiscence, occurring more than 3 months postoperatively. Predisposing factors may include pseudoexfoliation, trauma, uveitis, and previous vitrectomy. Repair of late, in-the-bag PCIOL dislocations can be challenging. The IOL-capsular bag complex is often associated with substantial residual cortical material, making the structure large and cumbersome to surgically manipulate. The majority of cases present with inferior subluxation and phacodonesis (Figure 1A). Posterior displacement of several millimeters is evident when the patient assumes a supine position (Figure 1B). Partial residual zonular competency is present in such cases, though a subset present with complete dislocations, requiring an alternate surgical strategy. Traditional approaches to in-the-bag PCIOL dislocations involve vitrectomy, retrieval of the IOL-bag complex, removal through the anterior chamber, and replacement with an anterior chamber or sutured PCIOL. Iris and corneal trauma are inherent in the manipulation of this large IOL-bag complex in the tight confines of the anterior chamber. Because of the growing population of patients with pseudophakia (secondary to the increasing incidence of phacoemulsification procedures performed over the last 20 years and a larger aging demographic) we may be facing an impending epidemic of late, in-the-bag PCIOL dislocations for which a facile surgical repair technique is needed. In this study, we describe a modified iris suture technique of displaced, in-the-bag, oneand three-piece PCIOLs that minimizes operative complexity and circumvents the need for secondary lens explantation and replacement.