In this video from Dr. Osher's Video Journal of Cataract and Refractive Surgery, Dr. Ike Ahmed manages a complex case of blunt trauma in which the patient presents with a dislocated cataract, an atonic pupil, and hypotony secondary to a cyclodialysis cleft.

Using liberal amounts of OVD, iris hooks, and a capsular tension ring, Dr. Ahmed first removes the cataract and implants a 1-piece acrylic lens into capsular bag. Attention turns to the atonic pupil which is reformed with a baseball stitch, incorporating small bites of the pupillary edge around all four quadrants. Sutures are tied but not locked.

A partial-thickness scleral flap allows access to the uvea and ciliary body. A pair of cross-mattress sutures pass through the scleral bed and anterior ciliary body to secure the tissue and resolve the dialysis. Finally, the surgeon returns to pupil where an iris or claw suture is used to titrate tension to size.