IOL Exchange + Autograft for Dislocated Sutured Lens with Scleral Defect

This is a case of a 9-year-old boy who underwent posterior vitrectomy with a scleral-fixated IOL using MERSILENE sutures for a posterior lens dislocation 15 months prior but who developed progressive IOL decentration and conjunctival erosion due to an unburied suture knot. An IOL exchange was planned to switch the scleral-fixated IOL for a retropupillary iris claw IOL. After placing a pars plana irrigation to avoid intraoperative hypotony, the existing IOL was secured with forceps while the MERSILENE knots were carefully separated from their adherence to the sclera. The iris claw lens was then fixated, and an autologous scleral patch graft was used to cover the scleral defect. At one-month follow-up, there were no signs of ocular inflammation, the IOL was well centered, and the scleral autograft was in place.

Financial Disclosures: Dr. Meriem Ouederni discloses no financial relationships. Dr. Fehmy Nafaa discloses no financial relationships.