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    By Richard S. Hoffman, MD
    AAO 2014
    Refractive Mgmt/Intervention

    This is a case of a senior with pseudoexfoliation in her right eye who elected to undergo cataract surgery with Array multifocal IOL implantation in both eyes. At the time of surgery in the right eye, there was no evidence of zonular weakness or compromise. Due to her pseudoexfoliative condition, a capsular tension ring was placed in the right eye. She did well postoperatively, but 7 years later, the IOL in the right eye developed pseudophacodonesis, and ultimately moderate IOL/capsular bag subluxation developed. She maintained 20/30 visual acuity through the subluxed lens, in part due to the use of peripheral IOL distant-dominant rings, but the significant pseudophacodonesis necessitated fixation of the IOL. Rather than performing an IOL exchange, the in-situ IOL was fixated using a scleral fixation technique.