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Thanks for nice contributions, there are multiple ways to manage difficult cases with lens subluxation. Surgeon is applying the method according to experience and availability of equipment. I do 25-23G pars plana core vitrectomy-limited central capsulectomy in such cases, sometimes iris retractors (not for this case which was erroneously replaced with another case description ) Anterior vitrectomy approach in my technique is not possible as I first place IOL over the capsule, not distorting the anatomy during that phase. Scleral incisions may also be preferred with advantages/disadvantages. We were lucky not to see retinal detachment in such cases although we were not able to check retina with indentation peroperatively buth with indirect ophthalmoscope later on. Retropupillary Artisan lens placement requires a high level of experience ( which I do not have) So next time we will consider all these very clever suggestions carefully.

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Dear Dr. Kayikcioglu thank you for such a nice video. In these cases i rather, (since im openning the cornea at leat 6mm) open a little more, do a intracapsular extraction, (previous viscoelastic under lens - to try to get the less vitreous) and then I do a small vitrectomy and place a aphakic retropupilar artisan lens. The surgery time is shortened by a lot. And the PostOp results have been great.

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Dear Ozcan Thank you for such a nice video. In those cases with Marfan, if Cionni ring is not an option I use Intrascleral Multipiece foldable PCIOL fixation (suggested by Dr. Schariot). Glue is not at all necessary to keep the IOL in place, but well made scleral tunnels are more essential. In case if PMMA IOL is used, probably it would be better to create Sclero-Corneal Frown shape incision (used for SICS surgery) which doesn't require sutures and causes less astigmatism. Once the vitrectomy is performed through the Pars Plana approach , the fundus periphery has to be checked at the end of the procedure otherwise RD risk is about 10 %, is this case it was not possible I guess, therefore anterior vitrectomy or Bag removal is better to be done with anterior approach. The surgery was very nice. Thanking you once again.

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i like glued iol better- smaller wound, better fixation. also, since rhexis was accomplished, why not suture in 1 or 2 ctr's and keep the bag?

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Glued IOL may be an alternative but it was not popular and widespread then, plus long term results in a young patient may be questioned. It is not possible to reposition the bag in severely subluxated lenses in my experience if the case is congenital not traumatic. The bag is peripherally left in this case after central vitrectomy, to clean the visual axis against opacificatins. Still residual capsula supported IOL. The case was operated with 23 G PPV. I have sent two cases for presentation and I think case descriptions mixed I also used 25 G Vitrectomy for such cases which is a good alternative for all anterior segment complications.

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