90 y o, 20 y after cataract surgery, 3 y after suturing of left eye, 20/400 preop, 20/40 post op, removal retained lens material
Why reposition and suture instead of replace
Replacement with large one piece PMMA sclerally sutured IOL» Requires large incision» Long healing time and visual recovery
– In older patients may be very significant time
Replacement with AC IOL» Longer healing time
dislocation after complicated cataract surgery in patient with NAG s/p PI OU, 20/200 preop, 20/50 post op fixation, secondary BK,
20/40 after DSEK
B, 70 y o Dsek 2007, lens sutured 2 years later, +cme
reasener
Oval pupil corrected with iridoplasty
After lens suturing and iridoplasty
Siepser knot
Why iridoplasty?
Better optics and less glare Less peripheral anterior Synecheia
» Less decrease in outflow Better tolerance of mild lens
decentration
Complications of repair
Retinal detachment Glaucoma
Corneal edema Cystoid macular edema
Recurrence of dislocations
Dislocated IOLs
A problem? YES When to treat:
» Prevention: larger capsulotomies,– Capsular tension rings?
» When lens causing symptoms or likely to sublux Surgical options With appropriate repair outcomes are excellent and recurrences
are rare The least invasive procedure is the best, iris suturing leads to
consistent excellent results