A case of vitreous dislocated IOL in a 65 years old man.
The IOL was difficult to re-fixate so we decide to remove it and insert a specifically designed IOL. This is a new foldable intra-ocular lens with two T-shaped haptics that are easily to insert in a 25G scleral tunnel. To avoid erosion of the overlaying conjunctiva a scleral flap is created to cover the external part of the haptics.
The surgery started with a complete vitrectomy to release every vitreous traction from the dislocated IOL, this was then placed in the anterior chamber, over the iris, cut in two pieces with a scissor and removed.
Scleral flap can be created at 6 o’clock and 12 o’clock hours as at 3 and 9 o’clock after opening of the conjunctiva in the same location. One’s the flap is ready a straight transscleral tunnel is opened with a 25G needle. The new IOL is inserted in the anterior chamber and let open over the iris. With 2 vitreous forceps the haptics are externalized through the sclerotomy under the scleral flaps. In this case a couple of scleral sutures were used to close the flap.
This lens can be inserted through a very small corneal tunnel and no sutures are needed.
In this case there was a residual astigmatism, two months after surgery, probably due to the scleral sutures. It is probably possible, in some case, to avoid those sutures with no induced astigmatism after surgery.