In this video we discuss some tips on vitrectomy for removal of a dislocated IOL.

In this case, a 61 YO male patient was submitted to PPV for repair of a macula off retinal detachment after complicated cataract surgery. Additionally, two single-pieces IOL were dislocated to the vitreous cavity.

In these cases, an anterior vitreous is first removed from the pupillary plane. The remaining lens cortex and the vitreous into the anterior chamber are also removed, and then the surgeon checks the capsular support. This information is important once, with an intact 360º capsular support, a 3-pieces IOL can be implanted in the ciliary sulcus at the end of the surgery. Additionally, the surgeon has to take care on how the IOL will be removed without damage in the capsular support.
In this particular case, only half of the capsular support was preserved.

Before removing the IOL, it's important to perform core vitrectomy, induce PVD and perform a meticulous shaving of the vitreous base. This way you can avoid iatrogenic breaks during IOL rescue.

A Perfluor bubble over the posterior pole, can help to protect the macula from any trauma and facilitates to grab the IOL with retinal forceps.

The positioning of the IOL into the anterior chamber can be a challenging step. Sometimes the IOL keeps dropping over and over again while the surgeon tries to place it above the iris plane.
In this step, you can use the bimanual technique, so while one hand grabs the edge of the IOL optic, the other hand pulls the haptic out through an anterior chamber paracentesis.

This maneuver allows for greater stability to cut the IOL with scissors and to remove it easier through the main corneal incision.
The second IOL was also removed using bimanual technique, but this time cutting the IOL optic directly through the corneal incision while the IOL was held in the pupillary plane.
Finally, the retina was reattached, and the secondary intraocular lens implant was scheduled for another surgical time.

Video:
Filipe Lucatto MD
Salvador 🇧🇷
Edition:
Filipe Lucatto MD
Juliana Prazeres MD
Salvador 🇧🇷

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