Successful Management Of A 10-Year-Old Subluxated Scleral-Fixated Intraocular Lens
Published 2025 - 43rd Congress of the ESCRS
Reference: PO837 | Type: Poster | DOI: 10.82333/9s22-b661
Authors: Lavinia-Ioana Ilina* 1 , Florian Balta 2
1Ophthalmology,Clinical Hospital for Ophthalmological Emergencies Bucharest,Bucharest,Romania, 2Ophthalmology,Clinical Hospital for Ophthalmological Emergencies Bucharest,Bucharest,Romania;Ophthalmology,University of Medicine and Pharmacy "Carol Davila" Bucharest,Bucharest,Romania
Purpose
This paper aims to present an optimal approach to a subluxated posterior chamber intraocular lens (IOL) with good postoperative results.
Setting
The rising mean life expectancy has led to an increased prevalence of cataract surgeries, consequently raising the incidence of IOL subluxation and dislocation. These complications present significant challenges for surgeons. Management strategies include IOL exchange, with or without suturing, and repositioning of the subluxated IOL. Among these, scleral fixation is preferred due to its minimal impact on anterior segment and a lower risk of postoperative astigmatism.
Methods
We report a case of a 67-year old caucasian female patient, diagnosed with open angle glaucoma and hypertension, admitted to the Ophtalmology Department for decreased vision and diplopia over her right eye. The patient had cataract surgery 10 years ago in both eyes (OU) with acrylic one-piece implants. Following a blunt ocular trauma a few months postoperatively, she had the right eye IOL luxated. She was subsequently referred to the vitreoretinal surgical department, where she underwent pars plana vitrectomy with scleral fixation of the IOL.
Results
At admission, her best-corrected visual acuity (BCVA) was 0.4 in the right eye (RE) and 1.0 in the left eye (LE), with intraocular pressure of 15 mmHg OU. RE slit-lamp examination revealed a subluxated IOL and an unreactive pupil. Fundus and optical coherence tomography were normal. Preoperative refraction showed high hyperopia and astigmatism.Surgery involved creating a scleral pocket, followed by a multiplane limbal incision. The subluxated haptic was externalized and a 10-0 polypropylene curved needle was passed through the scleral bed. It was externalized through the incision and tied at 1 mm from the distal end of the haptic. The scleral pocket was then sutured. One week postoperatively, RE BCVA improved to 0.8, with well-centered IOL.
Conclusions
This case illustrates the successful management of a subluxated IOL through scleral fixation, ensuring stability and optimal centration with minimal intraocular manipulation and favorable visual and refractive outcomes. The procedure was performed without the need for special surgical instruments.