Explantation Of A Dislocated Intraocular Lens With Simultaneous Reimplantation Using Flanged Loop Transscleral Monofixation In An Eye With High Hyperopia: A Case Report

To report the clinical outcome and technical feasibility of simultaneous explantation of a dislocated intraocular lens (IOL) with immediate reimplantation utilizing flanged loop transscleral monofixation technique in a highly hyperopic eye following clear lens extraction.

We report a case of a 35-year-old patient with grade II dislocation of the IOL–capsular bag complex after clear lens extraction for high hyperopia. The dislocated hydrophilic IOL was explanted in fragments through a corneoscleral tunnel with preservation of fibrosed capsular remnants. A +40.0 D foldable posterior chamber IOL was reimplanted using flanged loop transscleral monofixation. Postoperative UBM confirmed stable IOL positioning, followed by Nd:YAG posterior capsulotomy.

Results:

Stable centration and optimal posterior chamber positioning of the reimplanted IOL were achieved and maintained throughout the follow-up period, with no clinical or radiographic evidence of recurrent dislocation. Uncorrected distance visual acuity (UDVA) demonstrated significant improvement from 0.1 (20/200) preoperatively to 0.6 (20/30) postoperatively. Best-corrected distance visual acuity (BCDVA) improved to 0.8 (20/25). Ultrasound biomicroscopy confirmed sustained long-term biomechanical stability of the transscleral IOL fixation without evidence of suture erosion, haptic displacement, or inflammatory complications.

Simultaneous explantation and reimplantation of a dislocated IOL using the flanged loop transscleral monofixation technique represents a safe, efficacious, and surgically practical approach in eyes with high hyperopia and compromised capsular support. This technique provides reliable IOL fixation with favorable refractive and anatomical outcomes in complex clinical scenarios characterized by extreme refractive error and insufficient zonular or capsular integrity. Further investigation with larger case series and extended follow-up is warranted to establish long-term safety and efficacy parameters.