Eyeworld

DECEMBER 2020 | EYEWORLD | 43 C by Ellen Stodola Editorial Co-Director I n some cases, it may be necessary to refix- ate or remove an IOL after cataract surgery. Several surgeons discussed how they deter- mine when this course of action is needed and techniques they use. When you have a patient with a dislocated lens-bag complex, there are a variety of factors to consider, said Steve Safran, MD. First, he not- ed that you could be dealing with dislocation of the whole lens-bag complex where the zonules are shot; he usually uses a lasso in these cases. On the other hand, the capsular bag could be intact but within the lens is dislocated. "Your de- cision will depend on whether or not you want to keep that lens," Dr. Safran said. Choosing an appropriate option depends on the anatomy, your strategy, and if the IOL inside the eye is the one you want to keep. "Most of the time, they are lenses I want to get rid of," he said. Dr. Safran said in rare cases, comorbidities may influence the decision. If there's a filtering bleb, that might limit your angle of approach. If the patient is a high myope with a large eye, Pearls for refixating and exchanging IOLs continued on page 44 About the physicians Soon Phaik Chee, MD Singapore National Eye Centre Singapore Karolinne Maia Rocha, MD, PhD Director of Cornea and Refractive Surgery Medical University of South Carolina Charleston, South Carolina Steve Safran, MD Lawrenceville, New Jersey Dislocated single-piece IOL Source: Karolinne Maia Rocha, MD, PhD that will influence the decision. If the eye is bigger, it might be more difficult to do certain techniques. In terms of determining when a lens should be repositioned vs. exchanged, Soon Phaik Chee, MD, said this will often depend on the particular IOL. The design of the haptics, IOL power, and condition of the IOL all play a role, she said. The technique for fixation will also influence the decision—for example, if the IOL can be sutured to the iris or if it's going to be intrascleral fixation. Dr. Chee said she will do a supine exam, if a couch is available. "However, if a UBM has been done, I do not need to lie the patient down because the scan gives an image of the IOL with the patient in the supine position," she said. It's also important to consider iridodonesis. Eyes that have undergone surgeries, such as trans pars plana vitrectomy, or patients with floppy irises are more difficult to operate on, Dr. Chee said, explaining that it is difficult to suture an IOL to a floppy iris. "These eyes have more

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