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Thierry C. Verstraeten, MD, Garry P. Condon MD, Tyler Q. Kirk, MD
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Garry P. Condon MD, and Thierry C. Verstraeten, MD, present an IOL exchange case. The single piece acrylic lens fell posteriorly which required a little help from a vitreoretinal colleague. A 25-gauge pars plana vitrectomy and performed and the lens was brought anteriorly with microforceps. Once the IOL was returned to the anterior chamber, the lens was segmented with microscissors and removed. intraocular lens exchange with McCannel iris suture fixation. A new IOL is placed with an optic capture and the haptics were sutured to the iris via the Siepser sliding knot technique. Narrated by Tyler Q. Kirk, MD
Posted: 7/23/2012
Thierry C. Verstraeten, MD, Garry P. Condon MD, Tyler Q. Kirk, MD
Garry P. Condon MD, and Thierry C. Verstraeten, MD, present an IOL exchange case. The single piece acrylic lens fell posteriorly which required a little help from a vitreoretinal colleague. A 25-gauge pars plana vitrectomy and performed and the lens was brought anteriorly with microforceps. Once the IOL was returned to the anterior chamber, the lens was segmented with microscissors and removed. intraocular lens exchange with McCannel iris suture fixation. A new IOL is placed with an optic capture and the haptics were sutured to the iris via the Siepser sliding knot technique. Narrated by Tyler Q. Kirk, MD
Posted: 7/23/2012
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Tyler Kirk
12 years ago
Thanks for your comments. Here are my thoughts: 1. Garry not infrequently performs collaboration cases like this with Dr Verstraeten. Our VR folks have not indicated a problem with iris fixation. If the iris suture fixation is peripheral enough, it should not pose a problem for subsequent procedures should their need arise. Pharmacologic pupillary function is usually still possible if it existed preoperatively. 2. Certainly the options you list are possible ways to fixate a secondary IOL; however, we prefer iris suture fixation when possible for its reliable ELP and predictable outcome in our hands. (Dr. Condon and his former fellow, Dr. Dorey, have a nice AAO Focal Point from Sept 2009 on the appropriate management of dislocated IOLs where they feature several options for fixation, and when they may best be used.) 3. Controlled cutting of an acrylic IOL in the AC is facilitated by lots of viscoelastic, and careful manipulation with microforceps and microscissors from MST. We cut a pie shaped wedge that is approximately 2/3 the length of the optic. The only time I witnessed Garry expand the wound to remove the lens in toto was with a dislocated PMMA lens.
neeraj pandey
12 years ago
dear sir, your views on few comments: 1. does your VR friend like this iris fixation, in case he needs to re-operate for some peripheral retinal break? 2. why not SF? or simply externalization of haptics of 3 piece IOL? 3. how far it is recommendable to cut the IOL in AC and then explant? as it is not so uneventful as it looks in this edited video. anyways the wound was quite bigger, and slight more could bring the IOL out in toto without much maneuever. of course with a suture.