Stratos Gotzaridis MD

My Retina Athens Eye Center

Greece

Intraocular Lens centration and fixation or exchange

after a Lege Artis

cataract operation

Can be decentered or dislocated:

during Phaco

Just after Phaco

Long time after cataract surgery

IOLs

Decentration in the post op period

Due to external forces

trauma,

eye rubbing

or internal forces

scarring,

peripheral anterior synechiae [PAS],

capsular contraction,

size disparity

•With or without any other intervention!!!!

Dislocation after a uncomplicated Phaco operation

Without due to:

pseudoexfoliation s-me

long life artiphakia• fibrotic capsule,

• the weakness of the zinn zone,

• the weakness of the bag to hold the lens,

very young patients

the high myopic population,

Or trauma !!!

With due to:

• cornea transplantation,

• glaucoma surgery,

• retina or macula surgery

• uncorrected astigmatism,

• problems on the optic (opacities, cracks)

• intolerance of multifocal IOLs

IOL dislocation

Incidence 0.2 – 1.8%

Varieties

IOL-donesis

Sunset syndrome

Partially dislocated

Varieties

Totally dislocated in the vitreous cavity

Intraocular Lens centration and fixation

or exchange after a

Lege Artis

cataract operation

Intraocular Lens centration and fixation

or exchange after a

Lege Artis

cataract operation

Nice rhexis

Well centration

Fibrosis of the capsule together with IOL

•Result:

• En block decentration or dislocation

Management

Observation

Surgery

Observation +/- contact lens

Management

Surgery

Surgery

• 148 papers with different techniques published in Pubmed

No perfect technique, nether method better than the other

Varieties - Surgery

IOL-donesis

Sunset syndrome

Partially dislocated

Management options

Iris sutures IOL stabilization

Scleral sutures IOL

IOL exchange

IOL removal

Treatment options

• Although removal and replacement of the IOL with an A/C IOL is an option …..!!!!!

• It is not the best option !!!!!

A/C is not made for IOLs

A/C IOL complications

Corneal endothelial damage

Chronic irritation of the iris

Insufficient dilation if needed

Possible damage of the angle

Iris claw IOLs

A kind of more acceptable situation due to:

1. not harming the angle

2.the body of the IOL is more posterior to the endothelium

Iris fixation – McCannel suture

Iris sutured IOL

Iris fixation – McCannel suture

Chronic irritation of the iris

No good dilation if needed

Posterior synaeche

Dropped in the vitreous????

Scleral fixation

much more acceptable

• IOL in P/C

• Not harming the A/C components

Video

• That is for the easy cases!!

• More complex cases???

• Such us:

Young uveitic patient with MF-IOL donesis

Stickler’s s-me post RD cataract

IOL sunset

11yo one eye boy

Single eye traumatic Female pnt

Thank you