Internal Repositioning of Posteriorly Dislocated IOL: User’s Friendly Technique The author have no financial interest in the subject matter of this poster Authors: Dr Satyen Deka

Purpose Our study evaluates the technique of internal repositioning and scleral fixation of the dislocated IOL without explanting it.

Materials & Methods Settings & Design: Interventional non comparative study of consecutive cases Study Population:18 eyes of 18 patients that underwent vitrectomy and internal IOL repositioning for posterior IOL dislocation during at a tertiary eye care center All patients underwent a detailed ophthalmic evaluation Informed consent taken in all cases

Surgical technique Prefixed knots were used to secure the dislocated IOL heptics through pars-plana approach in the vitreous cavity and after repositioning the IOL behind the iris plane two-point scleral fixation is done.

8- cardinal Surgical steps 1.The dislocated IOL is freed from vitreous adhesions using 3 port pars- plana vitrecotmy 2.Using straight needle, 10-0 proline suturre passed thorough sclera 1.5 mm away from limbus into the eye and brought out in the opposite horizontal meridian guided by 30 gauge needle 3.The proline suture is pulled out from the vitreous cavity though one sclerotomy using vitreous forceps, and divided. 4.A loose knot is prepared at the cut end of both sutures 5.One prefixed knot is introduced into the eye and one heptic of the IOL is anchored first and the knot is tightened. 6.Similar procedure is done for the other heptic using the other prefixed knot 7.Pulling the external ends of the proline sutures in both sides the IOL is brought to the retropupillary plane 8.Using partial thickness bites both the ends of 10-0 proline are fixed.

Step 1 Step 3 Step 2 Step 4 Step 5 Step 6 Step 7 Step 8

Patient Characteristics Age range : years Male : Female 13:5 Left eye involved in 12 cases All cases were implanted with non foldable PMMA IOL Eventful cataract surgery was present in all cases Follow ups done on next day, 1 st post operative week, at 1 month and then 3 monthly

Results All the cases except one had successful internal repositioning with significant visual recovery as on last follow up. One case developed RD in the post operative period related to sclerotomy site break. One case need repeat surgery for slippage of one10-0 proline knot that fixates the IOL heptic Postoperative astigmatism was nil in one case and ranged from to -3.00diopter in 17 cases

Age Sex Log MAR presenting Vision Log MAR Final Post-op Vision 51M M M M M F M M F F M M M M F F M M1.70.1

Conclusion Posterior IOL dislocation is a known early or late complication Different surgical approaches are mentioned in literature with merits and demerits 1,2,3,4 Our technique of internal IOL repositioning obviates the need of IOL removal and there is no surgical trauma or related complication to the anterior segment

Conclusion This is an useful limbus sparring less traumatic technique for management of posteriorly dislocated IOL.

References 1.Lawrence FC II, Hubbard WA. “Lens lasso” repositioning of dislocated posterior chamber lenses. Retina 1994;14: Smiddy WE, Ibanez GV, Alfonso E, Flynn HW Jr. Surgical management of dislocated intraocular lenses. J Cataract Refract Surg 1995;21: Hu BV, Shin DH, Gibbs KA, Hong YJ. Implantation of posterior chamber lens in the absence of capsular and zonular support. Arch Ophthalmol 1998;106: Mello MO Jr, Scott IU, Smiddy WE, Flynn HW, Feuer W. Surgical management and outcomes of dislocated intraocular lenses. Ophthalmology 2000; 107:62-67.