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When should one re-dial a misaligned toric IOL

Poster Details

First Author: S.Chaudhary INDIA

Co Author(s):    S. Jindal                    

Abstract Details


A need may arise to redial an implanted Toric IOL. This may be a result of incorrectly positioned Toric IOL, or a Toric IOL which has rotated within the bag. It is known that there is a shrink wrap effect of the capsular bag which clamps over the IOL. This makes a late dialing of the IOL impossible or risky as it may avulse the zonules or tear the capsular bag. A right time for dialing needs to be documented.


Eye7 Hospitals, New Delhi, India


On detecting a mis-aligned hydrophobic Toric IOL, the surgeon dialed it at 2 weeks postop when the patient came for a regular followup visit. He recorded his observations. In another case, he tried to dial a similar IOL at 3 weeks postop. He again recorded his observatios


At 2 weeks postop, the surgeon attempted to dial the IOL with a lens dialer under cover of visco-elastics, but was unsuccessful. He tried to hydro-separate the IOL from the bag but was unsuccessful. He then tried to visco-separate the IOL from the anterior and posterior capsule, and was then successful in dialing the lens. In the other case where he tried to dial a similar lens at 3 weeks, the visco-seperation alone did not work. The anterior and posterior capsule of the bag had adhered over the haptics, making dialing difficult. The haptics had to be pulled out of its tract between the anterior and posterior capsule, the then the bag opened with visco and a probe


In our clinical practice, the patient is seen at 2 weeks for a final followup, and refracted on that day assuming negligible changes in refraction will take place after that. A refractive surprise at this stage may need an IOL dialing. It was comfortable to dial the lens at 2 weeks post op and difficult at 3 weeks post op. Dialing could become dangerous after 4 weeks postop.

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