Vitrectomy to remove a posteriorly dislocated endocapsular tension ring

We treated a patient who had a posteriorly dislocated endocapsular ring associated with decreased vision and intravitreal cortical remnants. The ring was removed by uneventful pars plana vitrectomy. By the last examination, best corrected visual acuity had improved to 6/12 and intraocular pressure had stabilized to within normal limits. A posteriorly dislocated endocapsular ring is a rare complication of cataract surgery. Its removal by pars plana vitrectomy under direct observation is effective and safe.     

Management of posteriorly dislocated introcular lens: a new technique

Many surgical techniques have been described in the management of posteriorly dislocated intraocular lens (IOLs). Lifting the IOL off the retina is a critical step during the surgical procedure. We describe a new simple and effective technique using an extrusion cannula that offers many advantages to lift the IOL in a safer and more controlled way.     

晶状体或人工晶体脱入玻璃体腔的手术处理

目的探讨晶体或人工晶体脱位入玻璃体腔的处理方法。方法钝挫伤后晶体脱位3眼,白内障手术中或术后晶体或人工晶体脱位11眼。均采用标准睫状体扁平部三切口闭合式玻璃体切除方式。术中注入全氟化碳液体0.4～4ml。经角膜缘取出人工晶体或晶体,或是直接玻璃体腔内粉碎晶体。再植入前房型人工晶体,或行后房型人工晶体睫状沟缝线固定。结果14眼均顺利取出或粉碎玻璃体腔内晶体或人工晶体。13眼(92.86%)术中植入人工晶体。术后视力明显提高12眼(85.71%)。结论对晶体或人工晶体全脱位进入玻璃体腔者,需争取早期采用玻璃体切除联合脱位晶体或人工晶体取出或粉碎手术,争取再植入人工晶体。     

Scleral fixation suture technique without lens removal for posteriorly dislocated intraocular lenses

BACKGROUND: Posterior chamber intraocular lenses (IOLs) may dislocate into the vitreous or over the retina at the time of, or several months after, surgery or following injury. Techniques described to reposition dislocated lenses have drawbacks, such as lens removal, lens exchange, difficulties of lens repositioning procedures and high cost We describe a technique in which the haptics of dislocated IOLs are fixed to the sclera after the haptics are externalized solely through a pars plicata incision site and tied with a 10-0 Prolene suture. METHODS: After pars plana vitrectomy, the IOL was grasped with an intraocular forceps and moved to the pupillary area. A second intraocular forceps was inserted from the site of planned fixation, and the tip of the haptic was pulled out and heated to form a knob to avoid suture slipping. A 10-0 Prolene suture was then tied to the haptic by means of a sailor knot The haptic was reinserted intraocularly, and the outstaying sutures were tied with conventional knots over the sclera or under the scleral flaps. The procedure was then repeated on the other side. RESULTS: This technique has been used in 12 patients (12 eyes), 7 men and 5 women ranging in age from 45 to 77 (mean 63.8 [standard deviation 8.5]) years. The time between diagnosis of dislocation and surgery was 10 to 20 days in six cases and 21 to 39 days in six cases. The IOL was dislocated into the vitreous in eight cases (67%) and over the retina in four cases (33%). The preoperative best corrected visual acuity ranged from 20/200 to 20/30. Intraoperatively, mild vitreous hemorrhage developed in two patients (17%), macular edema developed in two patients (17%), and rhegmatogenous retinal detachment developed in one patient (8%). The final visual acuity ranged from 20/50 to 20/20 in 11 patients; the patient with retinal detachment had hand movement vision. INTERPRETATION: The technique of scleral fixation of posteriorly dislocated IOLS without lens removal is a safe, inexpensive and useful complement to other techniques.     

Modified balanced two-string technique of internal scleral fixation of posteriorly dislocated intraocular lens

Posterior dislocation of the intraocular lens (IOL) is a rare but potentially dangerous complication encountered by a cataract surgeon. We describe a modified balanced two-string technique of internally fixing a posteriorly dislocated rigid IOL using the pars plana approach in eyes which lack adequate capsular support. Five eyes of five patients underwent the procedure. All eyes had successful IOL refixation. One eye had mild temporal decentration. BCVA improved in all patients. Our technique is an alternate method of scleral fixation of posteriorly dislocated IOL with advantages of minimal postoperative astigmatism, minimal anterior segment manipulation, and good IOL centration.     

Illuminated endochopper in the management of posteriorly dislocated lens nucleus

We describe the use of an illuminated endochopper (a prototype instrument produced by DORC International) in the management of a posteriorly dislocated lens nucleus or lens particles. This instrument helps to divide the lens nucleus or its fragments into small pieces and thus reduces time and ultrasound energy.     

Management of posteriorly dislocated intraocular lens using pars plana vitrectomy

In order to evaluate the results of pars plana vitrectomy (PPV) for the treatment of posteriorly dislocated intraocular lens (PC-IOL), we retrospectively examined and analyzed the hospital records of patients who had undergone PPV to exchange or reposition a PC-IOL dislocated into the vitreous cavity. Of 20 eyes in 20 patients, IOL exchange was performed in 6 eyes, and IOL repositioning in 14 eyes. Posteriorly dislocated IOL occurred in 14 eyes during or within 2 days, and in 6 eyes 6 months after the IOL implantation. Thirteen eyes were surgically treated early after the occurrence, within 3 days, while 7 eyes were treated later, between 5 to 7 days. Compared with preoperative best-corrected visual acuity, the final visual acuity improved more than 2 lines in 12 eyes. With no significant difference on the statistics, earlier visual rehabilitation seemed to be shown in late-treated patients than in early-treated. Accordingly, a posterior dislocation of IOL can be successfully treated with PPV, and barring any serious complications such as retinal detachment, there is no need for surgery immediately following the occurrence.     

Management of posteriorly dislocated endocapsular tension ring and intraocular lens complex

We report a case of late posteriorly dislocated endocapsular tension ring (ECR) and intraocular lens (IOL) complex into the vitreous cavity that behaved as a single 13 mm disc. A 3-port pars plana vitrectomy was performed, and perfluorocarbon liquid was used to retrieve the ECR-IOL complex to the retropupillary area. A 3-point scleral fixation was performed to reposition the inseparable ECR-IOL complex.     

Report of a repositioned posteriorly dislocated intraocular lens via pars plicata sclerotomy

A patient had an apparently uncomplicated extracapsular cataract extraction with insertion of a posterior chamber intraocular lens (IOL). Posterior dislocation of the implant was noted postoperatively. The IOL was successfully repositioned via a pars plicata sclerotomy and the haptic was sutured to the sclera. We believe this procedure is relatively atraumatic and is preferable to removal and replacement of a partially dislocated implant.     

Vitrectomy with endoscopy for management of retained lens fragments and/or posteriorly dislocated intraocular lens

• Purpose: To evaluate the advantages of vitrectomy combined with endoscopy for the management of retained lens fragments and/or posteriorly dislocated intraocular lens (IOL). • Methods: A consecutive series of 30 eyes with these complications treated by this technique was reviewed retrospectively. An endoscopic probe which incorporates a video channel, a fibreoptic light source, and a diode laser was used for visualization. Lens material or the IOL was extracted through the corneal wound in 18 eyes (60%). They were either aspired or grasped or lifted using perfluorocarbon liquids (PFCL), under endoscopic control. In 9 eyes (30%) pars plana phakoemulsification was performed. PFCL was used in 11 eyes (36.6%). In 16 eyes (53.3%) an IOL was sutured in the ciliary sulcus. • Results: Final visual acuity was ≥20/40 in 19 eyes (63.3%), ≥20/30 in 15 eyes (50%). Intraoperative breaks occurred early in the series in two eyes (in one case from use of the endoprobe, in the other from pars plana phakoemulsification). Poor final acuity was related to proliferative vitreoretinopathy, which developed in both cases with an intraoperative iatrogenic retinal break, senile macular degeneration, myopia and amblyopia, cystoid macular oedema, corneal oedema and high astigmatism. • Conclusion: We found that endoscopy facilitated the management of these complications of caratact surgery once the peculiar difficulties of the technique (absence of stereoscopy, manipulation of the endoprobe, video monitor control) were mastered. Endoscopy facilitated and shortened localization of lens fragments embedded into the vitreous base for aspiration, grasping and phakoemulsification, enabled detection of small anterior retinal breaks, permitted resection of adhesions between anterior hyaloid, lens capsule and ciliary sulcus and facilitated PFCL manipulations, whatever the status of the anterior segment (corneal edema, myosis, synechiae, presence of IOL). Received: 17 February 1997 Revised version received: 2 June 1997 Accepted: 23 June 1997     

Modified technique of haptic externalization for scleral fixation of dislocated posterior chamber lens implants

PURPOSE: To describe a modified technique of haptic externalization during repositioning of dislocated posterior chamber lens implants, which facilitates placement of scleral fixation sutures around the haptic for implant stabilization. METHODS: We describe a technique of repositioning a dislocated posterior chamber implant with scleral fixation sutures, which uses a small, clear corneal incision for externalization of the haptic. After a loop of 10-0 Prolene suture (Ethicon, Inc., Somerville, New Jersey) is placed around the externalized haptic, the sutures are retrieved through a sclerotomy 1.0 mm posterior to the limbus. The haptic is reimplanted into the ciliary sulcus. A separate scleral fixation bite closes the sclerotomy, and it is tied to the 10-0 Prolene sutures looped around the haptic. RESULTS: The dislocated implant was stable and fixated in good position 5 months after surgery using this technique. CONCLUSION: This externalization technique minimizes the extensive intraocular manipulations necessary to create a suture loop around a haptic of a dislocated implant. The clear corneal incision allows for clear visualization during externalization of the haptic.