Placement of an iris prosthesis has been shown to reduce glare and improve visual acuity. 1-3 Coexisting zonular weakness is common in congenital aniridic patients with progressive zonulopathy and trauma with iris defects. Accordingly, intracapsular devices are vulnerable to late capsular bag dislocation from repeat trauma, capsule contracture, or progressive zonulysis. 1,4 We report what we believe is the first use of a capsular tension segment to manage late subluxation of a capsular bag complex containing a posterior chamber intraocular lens (PC IOL) and 2 iris devices. CASE REPORTA 74-year-old man was referred for a subluxated unstable capsular bag complex containing a PC IOL and 2 iris prosthetic elements. Cataract surgery had been performed previously, and 1 year after the surgery, 2 interdigitating 50c elements had been implanted in the capsular bag to control glare from traumatic aniridia.Examination showed a mobile capsular bag complex "floating" over an intact hyaloid face. A dispersive ophthalmic viscosurgical device (OVD) was injected to open the capsulorhexis margin. Two type 6D capsular tension segments (Morcher GmbH), pre-threaded with 8-0 polytetrafluoroethylene sutures (Gore-Tex, W.L. Gore & Associates, Inc.), were serially placed into opposite fornices of the capsular bag ( Figure 1). Two sets of scleral openings were created superiorly and inferiorly at the level of the ciliary sulcus. The blunt suture ends were respectively retrieved from the anterior chamber with a 23-gauge microforceps via the scleral openings and externalized. Suture tension was adjusted, recentering and stabilizing the capsular bag complex containing the IOL and iris prostheses (Figure 2). The knots and tags were rotated internally and covered by both conjunctiva and Tenon fascia.The postoperative course was unremarkable, with visual recovery to baseline and sustained significant subjective decrease in glare. DISCUSSIONA variety of techniques have been described to manage subluxated IOLs. Repositioning a capsular bag with a rigid iris prosthesis in situ can be very challenging since sutures cannot pass through rigid poly(methyl methacrylate) (PMMA) material. In addition, passing sutures through the bag between the elements could result in splitting the bag because the prosthesis prevents fusion of the anterior and posterior capsule leaflets, unlike when the bag is occupied by an IOL alone. We are aware of only 1 unreported case in which an in-the-bag PMMA iris prosthesis-IOL complex was repositioned without exchange by placing sutures directly through the acrylic optic of the IOL and then securing it to the sclera, which required considerable surgical dexterity. A In the case we describe, we were able to successfully suture refixate the bag complex using capsular tension Figure 1. Capsular tension segment is placed into the inferior capsule fornix. The white arrow shows the device sliding under the capsulorhexis margin.Figure 2. At the end of the case, the PC IOL-capsular bag-iris prosthesis complex is centered and stabl...