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Dislocated IOL, Suture Refixation, Pars Plana Needle Assist

Tyler Kirk, MD

A patient presented with a spontaneous dislocated in-the-bag IOL. They had a history of uncomplicated cataract surgery 4 years earlier, and a year prior to that the patient had undergone a scleral buckle with pars plana vitrectomy for a rhegmatogenous retinal detachment. Nonpreserved lidocaine followed by dispersive viscoelastic was inserted. A pars plana 27-gauge needle attempted to elevate the IOL-bag complex. The first pass was unsuccessful, but on the second attempt the IOL was brought up. A double armed 9-0 polypropylene suture on a long curved needle was inserted through an inferior paracentesis. After three attempts to secure the capsule at the margin of the superior capsulorrhexis, the needle was successfully passed through the capsule, and then up superior midperipheral iris and peripheral cornea. The second arm of the suture passed through the inferior paracentesis, and up through midperipheral iris about 1 clock hour apart from the initial pass and out peripheral cornea. The IOL-bag complex was secured to the iris via a Siepser sliding knot, with a four-throw followed by a second securing single throw. The knot was cut with MST microscissors. Viscoelastic was irrigated out, with bimanual irrigation and aspiration, and moxifloxacin instilled. A laser peripheral iridotomy was placed afterwards to eliminate risk for pupillary block. On post operative day 1 the patient had regained his best pre-dislocation vision of 20/40.

Posted: 5/16/2025