JUL 15, 2011
The authors describe a method for surgically managing an IOL-capsular bag complex subluxation that involves centering and fixating the IOL-capsular bag complex to the sclera using the fibrotic ring that develops around the continuous curvilinear capsulorhexis (CCC). At least two double-armed 10-0 polypropylene sutures are passed around the fibrotic CCC rim of the capsule and out of the Hoffman scleral pockets and then tied in the scleral tunnels to center the IOL-bag complex. The authors say that this alternative approach to repositioning and fixating the IOL-bag complex is especially useful in cases in which removal and replacement of the IOL would be difficult.
I saw this technique presented at ASCRS in relation to the "epidemic" of in-the-bag dislocated IOLs. Its drawbacks are that you have to have fibrosis of the rhexis rim and there is the possibility of a tear in the bag.
The authors, however, say that repositioning and fixating a dislocated IOL-bag complex offers the advantage of avoiding a large limbal incision, which reduces the risk for postsurgical astigmatism and trauma to the corneal endothelium. They say that fixating the fibrotic CCC of the capsular bag to the sclera is most helpful in situations in which there is limited access to the IOL due to poorly dilating pupils, a thick Soemmerring ring or a subluxated IOL-bag complex in which it can be difficult to visualize the IOL haptics secondary to opaque cortex. They note that this technique allows greater surgical maneuverability to achieve IOL-bag fixation.