Channels: Retina | Posted 9/11/2018
This is a 31 year-old oilfield worker who has a complex past ocular history notable for over 10 left-eyed surgeries (largely pediatric) including CE/IOL OS at age four. After disappearing from Texas Retina in 2014, he resurfaced in April of this year with persistent panuveitic inflammation and CME thought to be secondary to iris-lens chaffing. Until that time, he had been appropriately maintained on a steady dose of Nevanac (Alcon) by his local optometrist; that said, the patient confessed that he was "sick of drops" and presented for second opinion hopeful for a more permanent solution. Ozurdex was given at the time of presentation which did serve to eradicate edema and quell inflammation but only for a handful of months.
With inflammation once again making itself known, the patient was referred to cornea in early July for an opinion regarding the role this patient's lens was playing in his chronic uveitic edema. They affirmed that the ring-shaped residual lens material had ballooned and hardened after 27 years of intraocular hydration and exposure. And so, chronic inflammation resulted, both a result of antagonistic lens proteins and physical chaffing of the iris. Cornea felt that a posterior approach would be best so vitreoretinal surgery was scheduled.
As the video illustrates, it would have been nearly impossible to effectively and completely remove the culprit lens material without sacrificing the bag and longstanding IOL. Fortunately, I was able to utilize the sutureless scleral lens rescue/refixation technique, one largely pioneered by my Dallas-based colleague, Ashkan Abbey, MD. The IOL and its haptics were remarkably sturdy 27 years after implantation, and the patient was 20/60 (sc) on POD# 6 (without any CME as confirmed by OCT). I expect further improvement in the coming weeks.
Cortical Removal • Dropped Lens • IOL Fixation • Phacofragmatome • Scleral-fixated IOL