Background: It is not uncommon to encounter a case of posterior dislocation of the intraocular lens (IOL). A bimodal trend is seen where posterior dislocation can occur soon after the cataract surgery due to an intraoperative rent in the posterior capsule. 1 Late dislocations can be seen following either trauma or due to zonular loss in old age or uveitis. 2,3 We present a series of videos depicting management of posteriorly dislocated IOLs in various situations. Purpose: We present surgical videos showing IOL refixation in cases of posterior dislocation of the IOL. The surgeries shown include repositioning the IOL over residual capsular rim, lasso technique for complete internal IOL refixation, a cow-hitch technique for securing IOL, refixation of an IOL along with capsular bag complex, IOL exchange with 4-point scleral fixation (SFIOL) with Goretex suture, and refixation of a previously sutured SFIOL, which is dislocated. Synopsis: Apart from reduced vision, the dislocated IOL can potentially cause retinal injury, glaucoma, or bleeding. 4 This video shows various case scenarios of posterior IOL dislocation and their management using various techniques. The common thread is scleral fixation using sutures and without exteriorizing any part of the dislocated IOL. Highlights: The video highlights different surgical approaches and techniques to manage a traumatic or spontaneous posterior dislocation of an IOL. It particularly highlights the technique of lasso using Prolene or the sturdier Goretex suture for fixing the IOL to the sclera without exteriorizing it. This mitigates the risk of infection. The exact marking of the four fixation points 180 degrees apart under scleral flaps ensures good centration and prevents suture exposure or infection. 5 With minimal risk of retinal detachment or bleeding, any IOL can be repositioned using one of these techniques. However, it is a demanding surgery requiring dexterity and bimanual maneuverability. Conclusion: Traumatic or spontaneously dislocated IOL can be rescued by refixing it to sclera using various techniques with either Prolene or Goretex suture with successful results. Video Link: https://youtu.be/8VvQAHX2-tk
Ratra et al. (Thu,) studied this question.