Modified technique may reposition dislocated polymethylmethacrylate intraocular lenses with eyelets: IJO

Management of dislocated IOLs is a challenging surgical problem. Several management techniques have been reported, including IOL exchange and refixation. Compared to IOL replacement, IOL refixation is preferred because it avoids large corneal/scleral incisions and causes less surgical trauma in a closed‑eye system.

In this study, authors successfully achieved transscleral suture refixation of PMMA IOLs with eyelets using 25‑gauge vitreoretinal forceps and 30‑gauge needles commonly used in vitreoretinal surgery. This modified technique can reduce trauma because neither haptic externalization nor scleral flap is necessary. It allows for easy IOL fixation by suturing through the IOL eyelet using a bimanual approach.

In the study, the satisfactory outcome of this technique demonstrates its efficacy and safety in treating dislocation of scleral‑sutured PMMA IOLs. CZ70BD and black diaphragm were used for a scleral‑sutured, nonfoldable PMMA IOL that has an overall tip‑to‑tip size of 12.5 or 13.5 mm. In addition, this technique minimizes surgical trauma to the intraocular tissue which is caused by adverse contact with the hard IOL. All manipulations are performed with the IOL in the anterior vitreous cavity, which is a relatively spacious and safe place for a variety of surgical procedures.

In conclusion, dislocated PMMA IOLs with eyelets can be safely managed with our technique, which is minimally invasive and provides great benefits. This study was limited by the small sample size because IOL dislocation occurs infrequently. Studies covering more cases with a longer follow‑up time are needed to assess other possible complications.

Source: Gao Y, Xing X, Zheng K, Wan L. Modified technique for repositioning dislocated polymethylmethacrylate intraocular lenses with eyelets. Indian J Ophthalmol 2024;72:1064-7.