1. Intraocular lens repositioning in a glaucoma patient with recurrent pupillary capture
Kyoung Tak Ma¹, Hyung Won, Bae² , Gong Je Seong², Chan Yun Kim² Jeil Eye Clinic ,Suwon, Korea¹,
Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea²
Purpose
IOL repositioning in a patient with recurrent IOL capture is a situation not rare to glaucoma patients who have received cataract surgery. Also, it is a very frustrating condition and in some cases, results in devastating consequences. Repositioning the captured IOL might be the treatment of choice but in some cases, due to the vulnerable status of the eye, anterior chamber collapse or bleeding might occur during manipulation. So, we would like to introduce a more simple method of repositioning the captured IOL.
Methods
In this particular patient, due to poor IOP control, Amhed valve implantation was performed at the same time as IOL repositioning. First, Amhed valve was inserted to its position. Intraocular lens was found to be slightly dislocated from 3 o'clock area to 6 o'clock area through the dilated pupil. 2 scleral flaps were made at 3 o'clock and 9 o'clock position. Using double armed straight needle with 10-0 prolene, both needles were penetrated from 9 o'clock position scleral flap to the 3 o'clock position scleral flap and by forming a rectangle formation, IOL was repositioned centrally. Suture was made at 3 o'clock position scleral flap using both ends of the 10-0 prolene. BSS irrigation was done into the anterior chamber. 2 sutures of rectangular shape scleral flap were done with 10-0 nylon. After the determination of adequate length of Ahmed valve, the tube of the Amhed valve was introduced into the anterior chamber through the puncture site and tied on to the sclera. Conjunctival and Tenon's capsule incision was water-tightly sutured continuously with 8-0 vicryl layer by layer.
Figure 3. Surgical technique of IOL repositioning with recurrent pupillary capture
The leading double armed straight needle is inserted through the partial thickness scleral flap and
is guided by the 27-gauge dental needle. B. The leading needle guided by the dental needle is pulled
through the scleral flap on the opposite site. C. The other end of the long needle is also pulled to
opposite site to the sclera flap. D. Sutures are fixated under the partial sclera flap.
Results
Patient has been followed up for three years and there was no further IOL capture and IOP was under good control. A
Figure 1. Preoperation photo of a pupillary captured IOL
Figure 4. Postoperation photo of a repositoned IOL
Conclusion
IOL repositioning in a patient with recurrent IOL capture is a situation not rare to glaucoma patients who have received cataract surgery.
We would like to introduce a more simple method of repositioning the captured IOL.
Although further evaluation would be needed, this new surgical technique of IOL repositioning might be helpful for managing cases with recurrent IOL capture. However considering the limitation of cases, a larger follow-up group would be necessary.
Figure 2. Schematic drawing of IOL repositioning recurrent pupillary capture
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