Reposition Of Subluxated Multifocal Intraocular Lens In A Patient With Pseudoexfoliation Syndrome-Case Report

To present a management strategy for subluxation of a multifocal intraocular lens (M-IOL) in a patient with pseudoexfoliation syndrome (PXF), aiming to preserve the original lens and maintain postoperative spectacle independence.

This case was managed in the ophthalmology clinic of a public hospital WIML

A 69-year-old male with unilateral visual impairment and a history of bilateral cataract surgery with multifocal intraocular lens (Zeiss AT LISA) implantation presented with inferior subluxation of a posterior chamber M-IOL associated with pseudoexfoliation syndrome. The patient wished to retain the original M-IOL and restore spectacle independence. After discussion of risks and alternatives, transscleral fixation of the subluxated IOL was planned.

Two surgical procedures were performed at a one-month interval. The first procedure consisted of repositioning the subluxated multifocal posterior chamber IOL using a 4-flanged transscleral fixation technique with 6-0 polypropylene sutures combined with mechanical anterior vitrectomy. The second procedure involved shortening of one fixation suture and further lens repositioning to improve centration and correct significant residual astigmatism (−1.75/−3.75 × 59°).

After two surgical interventions, there is residual refractive error of −2.50 / −1.75 × 63°, which could be best corrected by the safest method in the patient’s case: laser refractive surgery. Correction of residual ametropia and adjustment of the final outcomes in pseudophakic patients using excimer laser corneal surgery is both safe and predictable. Laser refractive surgery avoids the complications associated with intraocular procedures, provides greater flexibility, and achieves satisfactory outcomes, especially involving unexpected postoperative astigmatism.

Implantation of multifocal IOLs in patients with pseudoexfoliation syndrome or other causes of zonulopathy remains controversial due to the risk of late subluxation. Currently available scleral fixation techniques are limited by IOL design and cannot be applied to most multifocal lenses. In this case, the material of the original M-IOL (hydrophilic acrylic with hydrophobic surface properties) was suitable for scleral fixation, prompting lens repositioning with the option of subsequent laser refractive surgery. Achieving a solution that meets patient expectations while maintaining high standards of clinical safety remains challenging.