Eyeworld

56 | EYEWORLD | JUNE 2022 ATARACT C Relevant disclosures Mamalis: None Safran: None Contact Mamalis: nick.mamalis@hsc.utah.edu Safran: safran12@comcast.net [patients who have pseudoexfoliation or who've had vitrectomy]. If the IOL-capsular complex begins to dislocate, you want to recognize that early on when there is a chance to suture the complex to the ciliary sulcus." He said that in the laboratory, he has received spontaneously dislocated IOLs where there is a beautifully centered capsular tension ring within the capsular bag, but the complex still dislocated. Another tactic, if there is known, diffuse zonulopathy, is to put the IOL in the sulcus and capture the optic in the capsulotomy, Dr. Mamalis said, noting that there are not studies to support that this prevents late dislocations. When late lens-bag dislocation occurs, Dr. Safran said there are a number of ways to han- dle it, depending on the presentation and other factors. He said he would lasso the lens-bag complex under certain conditions: if the patient was happy with the lens before, if it was the right power and undamaged, etc. He will not scleral fixate hydrophilic acrylic lenses due to their propensity to calcify over time; he'll take those out. He would also take out lens-bag complexes that have a lot of Soemmering's ring material because it's pro-inflammatory. If the lens is sit- ting on the retina, if it's a Crystalens (Bausch + Lomb), or a plate-haptic lens, he said he'll usu- ally take it out. He'll also take out a dead bag, which he explained is so diaphanous it shreds if you try to do anything with it. "The capsular bag itself has to have enough fibrosis to hold," he said. When it comes to putting in a new IOL, Dr. Safran will generally do the Yamane double- needle intrascleral haptic fixation technique. There are rarer indications where he'll use GORE-TEX sutures. While there are techniques to fix dislocated lens-bag complexes, Dr. Safran said they're not things surgeons should "dabble in." "If you're only going to do this once or twice a year, I wouldn't mess around with it because there is a lot of potential to cause problems if you don't do it correctly," he said. "A lot of the ones referred to me are revisions of cases other people tried to do, and they've dug a deeper hole for the patient. … If it's not something you plan on doing frequently or do on referral, consider referring to someone who does a lot of them." Dr. Safran said while patients might notice a change in their vision or a bobbing of the IOL, sometimes it's the physician who notices the lens-bag complex is beginning to dislocate. If it's not fully dislocated and not impacting the pa- tient's perception of their vision, it's reasonable to wait to repair this until the patient becomes aware of symptoms or develops a problem relat- ed to the IOL dislocation. "Ophthalmologists often think that there is an urgency to these procedures because the lens may dislocate posteriorly. However, it's easier to justify surgical repair on a patient once they've developed symptoms related to the dislocation because they're more accepting of having a surgical procedure and all that comes with it," Dr. Safran said. "Also, there are excellent tech- niques for dealing with IOL bag complexes that dislocate posteriorly so really there is no urgen- cy for these patients to have surgery unless they have a visual problem or uveitis-glaucoma-hy- phema syndrome related to the IOL." continued from page 55 Learn more about dead bag syndrome in this EyeWorld Online Exclusive.

• Cover