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
Advantages of IOL repositioning include generally less morbidity (no need for anterior incisions and corneal endothelial cell loss-inducing traffic through the anterior chamber), and there are many techniques; these commonly share similarities with secondary or exchanges for PC-IOL implantation.
The purpose of this chapter is to describe this author’s technique for scleral suture “rescue” of a dislocated IOL (see accompanying Video 26.8.4 of a one-piece acrylic IOL repositioning with sutures). Additional advantages of this technique include its versatility – it can be performed in the setting of previous glaucoma procedures, previous corneal surgery (penetrating or lamellar keratoplasty), is amenable to use with all caliber vitrectomy systems, and is modifiable for a broad spectrum of PC-IOL styles including multifocal lenses.
The surgical steps include the following:
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