Surgical treatment of a dislocated intraocular lens–capsular bag–capsular tension ring complex

Abstract

We describe a surgical technique for managing late dislocation of an intraocular lens-capsular bag-capsular tension ring (IOL-CB-CTR) complex. Two 10-0 polypropylene sutures are placed transsclerally over and under the CTR through the anterior and posterior capsules to capture the CTR, which then is retracted and sutured through the sclera. The same maneuver is performed 180 degrees away. This simple, easy, effective procedure can be performed with a small corneal incision and does not require extraction of the IOL-CB complex. Although the CTR does not completely prevent IOL-CB dislocation, it provides the possibility of suturing the IOL-CB to the sulcus without replacing the IOL.

Surgical management of late dislocated lens capsular bag with intraocular lens and endocapsular tension ring

“…There is a single case report of a subluxated IOL-CB-CTR complex that was repositioned by using transscleral sutures passing over and under the CTR, through both anterior and posterior capsules to secure the IOL-CB to the sulcus. 3 This differs from our case, which was a luxation; ie, complete dislocation. In other reports of CTR dislocations into the vitreous, 1 was caused by extension of an existing posterior capsular tear.…”

“…2 However, even after implantation of a CTR, subluxation of the entire IOL-CB-CTR complex can occur. 3 We report a patient who presented with late spontaneous dislocation of the entire IOL-CB-CTR complex. To our knowledge, there have been no case reports of late spontaneous dislocations of entire IOL-CB-CTR complexes.…”

Late spontaneous in-the-bag intraocular lens and capsular tension ring dislocation in pseudoexfoliation syndrome

“…Other surgical treatment options for late combined dislocated IOLs and CTRs have been reported, including a 3-port pars plana vitrectomy with IOL and CTR explantation through the enlarged original clear corneal tunnel and implantation of a scleral suture-fixated posterior chamber IOL 13 or transscleral suture fixation of the IOL-CTR-capsular bag complex without removing it. 14 Capsular tension ring modifications for suture fixation may help to avoid this late complication in PEX eyes with phacodonesis. The Cionni-modified CTR allows scleral fixation through 1 or 2 eyelets.…”

Scleral fixation without conjunctival dissection

“…[4][5][6] Although iris fixation of decentered IOLs is a popular technique, late-onset combined IOL-capsular bag subluxation resulting from zonular weakness or dialysis may be more easily repaired with scleral fixation. [7][8][9] Techniques for transscleral fixation include ab interno methods, [10][11][12][13][14] in which the suture is passed from the inside of the eye to the external surface, and ab externo methods, [15][16][17][18] in which the suture is initially passed from the external surface. Common to all techniques for transscleral fixation is the need to bury, cover, or rotate the knot created for fixation so conjunctival erosion and subsequent endophthalmitis is less likely to develop.…”