Retina Surgery Retina Pearls Section Editors: Dean Eliott, Md; and Ingrid U. Scott, Md, Mph

MARCH 2012 I RETINA TODAY I 29 D islocated intraocular lenses (IOLs) are known possible sequelae of complicated or uncomplicated phacoemulsification surgery, particularly in patients with a history of trauma or pseudoexfoliation syndrome. Numerous techniques for lens refixation exist, most of which involve the need for a combined vitrectomy with scleralor iris-fixation of lenses. Large studies have evaluated the optimal lens selection at the time of the initial cataract extraction in cases of sufficient and poor capsular support, but no definitive conclusion has been made at this time.1-3 Scleralor iris-fixated lenses can be placed without the need for a primary pars plana vitrectomy at the time of the initial cataract surgery. After a lens has dislocated, however, vitrectomy and posterior segment techniques are frequently employed. An inferiorly dislocated IOL, with adequate support from the capsule or anterior hyaloid face to remain in the sulcus plane, can be retrieved safely and affixed to the sclera without the need for a concomitant vitrectomy. The singlepoint rescue technique described in this article is ideally used for an inferiorly dislocated 3-piece IOL with polymethylmethacrylate (PMMA) haptics; however, the indications can be expanded as additional cases are performed without observed long-term complications. The advantages of our technique are that it does not require special sutures or eyelets in the lens to stabilize it to the sclera, and it is relatively straightforward and easy to perform. TECHNIQUE A superior conjunctival peritomy is created extending from 10 to 2 o’clock. A partial thickness scleral flap is created and centered around 12 o’clock using a crescent blade. Next, a 20-gauge sclerotomy, placed 2 mm posterior to the limbus, is created parallel to the iris plane in the bed of the partial-thickness scleral flap (Figure 1A). A 10-0 polypropylene suture is loaded into the bore of a long, hollow 25-gauge needle with a tail emerging from the tip. Just posterior to the sclerotomy, within the bed of the partial-thickness scleral flap, the needle is inserted in the same plane, parallel and posterior to the iris plane, into the ciliary sulcus space. The needle, with the accompanying 10-0 polypropylene suture, is then passed under the iris and superior haptic and over the optic, exiting 180o from its initial insertion through the inferior peripheral clear cornea at the limbus (Figure 1B). The suture is externalized and held as the 25-gauge needle is withdrawn from the eye through its superior insertion site, leaving the suture in place across the sulcus and anterior chamber (Figure 1C). Next, a curved, rounded “shepherd style” hook4 is passed through the previously created sclerotomy, coursing under the iris and over the superior haptic to retrieve the 10-0 polypropylene suture (Figure 1D). It is important to avoid using a straight or purely bent hook to prevent hooking the vitreous and creating posterior segment pathology. The suture is then removed with the hook Single-point Scleral Fixation of a Decentered IOL Without Vitrectomy