26 Lens Management
26.1 Phaco-Vitrectomy
26.2 Pars Plana Lensectomy
26.3 Intraocular Lens Explantation
26.4 Secondary Intraocular Lens Insertion Clinical Scenarios & Clinical Decision Making
26.5 Sulcus Intraocular Lens
26.6 Anterior Chamber Intraocular Lens
26.7 Iris Fixated Intraocular Lenses
26.8.1 Scleral Sutured Intraocular Lens – Traditional 2 Point Fixation
26.8.2 Scleral Sutured Posterior Chamber Intraocular Lens 4 Point Fixation
26.8.3 Scleral Sutured Posterior Chamber Intraocular Lens – “Hoffman” Corneoscleral Pockets
26.8.4 Alternate Technique to Rescue a Dislocated IOL – Triangular Scleral Flap, Sutured IOL Technique
26.8.5 Suturing Without Exchanging the Intraocular Lens
26.9 Sutureless Scleral Fixation of an Intraocular Lens
26.5 Sulcus Intraocular Lens
A new or repositioned IOL can be placed in the ciliary sulcus if there is adequate capsular support.
1. Complete all Necessary Procedures such as Vitrectomy and Inspection of the Retinal Periphery.
Ensure removal of all anterior vitreous and any vitreous prolapsed above the iris plane. Triamcinolone acetonide can be useful to assist in visualizing vitreous.
2. Ensure Adequate Sulcus Support
Through a paracentesis wound inflate the ciliary sulcus with viscoelastic. Use a Kuglen hook if necessary to displace the iris and visualize the edge of the anterior capsule. Iris retractors can be used as needed to ensure adequate exposure. As a guide, at least 270 degrees of intact capsule is required to place a sulcus IOL.
3. Create a Main Corneal Wound
This wound should be oversized to approximately 3.5mm using a keratome.
4. Insert the Sulcus Intraocular Lens
This should be a three-piece acrylic lens. It can either be injected or folded. Ensure as the lens is inserted that the first haptic is captured in the sulcus and the lens is in the “reverse S” configuration. Leave the trailing haptic outside of the main wound (Figure 26.5.1).
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Westmead Eye Manual
This invaluable open-source textbook for eye care professionals summarises the steps ophthalmologists need to perform when examining a patient.
