Unique approach to managing a posteriorly dislocated IOL

Reviewed by George Beiko, MD

St. Catharines, Ontario-When a three-piece IOL intended for sulcus placement dislocates posteriorly during an IOL exchange procedure, cataract surgeons can consider several possible strategies.

The options include leaving the dropped lens in the posterior segment while implanting either a posterior chamber or anterior chamber IOL or simply leaving the patient aphakic with the dropped IOL. Alternatively, surgeons might attempt posterior-assisted levitation of the dislocated implant or seek assistance of a vitreoretinal surgeon.

When deciding among these approaches, surgeons may take into account a variety of factors that include their own experience and skill set, the age of the patient, the anatomy of the eye, and the availability of a vitreoretinal colleague.

When faced with this clinical scenario in an 85-year-old man with a history of vitrectomy with endolaser for retinal detachment repair, George Beiko, MD, implemented a novel, gravity-based solution. He had the patient turn over onto his abdomen so that the man’s head extended over the end of the operating table face down.

Inventive approach

Lying on the floor on his back so that he was looking up at the patient and with a colleague shining a flashlight in the patient’s eye, Dr. Beiko watched the IOL float anteriorly.

Next, he injected viscoelastic into the anterior chamber and externalized the haptics. After having the patient turn over onto his back, Dr. Beiko successfully completed the exchange procedure with sulcus placement of a new three-piece IOL.

When a three-piece IOL intended for sulcus placement dislocates posteriorly during an IOL exchange procedure, George Beiko, MD, implemented a novel, gravity-based solution. He had the patient turn over onto his abdomen so that the patient head extended over the end of the operating table face down. Courtesy of George Beiko, MD

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