MANAGEMENT OF COMPLICATIONS OF INTRAOCULAR LENSES: IN THE WAY OF A VITRECTOMY GUY

To present several approaches to manage intraocular lens (IOL) complications based on specific circumstances and to evaluate the treatment outcomes.

Case reports with videos of the surgeries and postoperative photos.

Based on the circumstances of each patient suffered IOL complications, the management was planed and adjusted during the operation (vitrectomy techniques and endoscope was applied when necessary):

1.In cases of minor IOL decentration accompanied by minimal iris incarceration, gently press the sclera at the IOL haptic region after pupil dilation. If this approach is unsuccessful, the IOL can be repositioned by pressing the IOL by a needle after anterior chamber paracentesis.

2.When a majority of the lens capsule remains intact and the IOL is displaced towards the site of capsule rupture (or break of the lens zonule), single suture of the weakened area of the IOL or scleral fixation can be implemented.

3.If a significant portion of the lens capsule (or the zonule) is non-functional, or if the IOL is unstable following single haptic fixation, double haptic fixation should be considered.

4.For cases which one of the haptic of a soft IOL was torn off, the edge of the optical portion of the IOL can be sutured through two scleral puncture sites, allowing for adjustment and secure fixation.

5.When the IOL has dropped into the vitreous cavity, vitrectomy can be performed. The IOL can be removed or scleral fixed.

6.In cases involving combined vitrectomy, two trocars can be pre-placed in an oblique, opposite direction at the positions corresponding to the IOL haptics. These two scleral puncture sites can be utilized to fix the IOL vitrectomy.

7.During the removal of the IOL (along with the dislocated lens capsule), it can be extracted through either a corneal or scleral incision. When passing through the cornea, partial incision of the IOL's optical zone by lens scissors.

8.For four - haptic IOLs, two sutures can be employed. Each suture should pass through two haptics and exit through separate scleral incisions.

9.When the cornea is not clear enough, the dislocated IOL in the vitreous can be extracted combined with vitrectomy by the use of an endoscope.

By selecting the appropriate management strategy according to the direction and degree of IOL dislocation, as well as the status of capsule damage and the IOL itself, favorable outcomes can be maximally achieved. If necessary, a more suitable IOL can be implanted at a later stage.

Timely and appropriate management of the IOL complications, significant visual improvement and minimum side effects can be achieved for the patient.