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Iris fixation of dislocated IOL in a patient with pseudoexfoliation

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Title: Iris fixation of dislocated IOL in a patient with pseudoexfoliation
Author (s): Russell Swan, MD; Alan Crandall, MD
Date: 01/01/2016
Keywords/Main Subjects: Pseudoexfoliation; Iris fixated; Dislocated IOL
Diagnosis: Pseudoexfoliation; Dislocated IOL

Description: This case is from a 74 year male with a history of pseudoexfoliation and previous cataract surgery at an outside institution 14 months prior who presented with a sudden decrease in vision.  He was found to have a partially dislocated IOL/capsular bag complex. After discussion of the risks/benefits/alternatives to surgery with the patient the patient elected to proceed with surgery and planned iris fixation of the existing 3 piece IOL.

This video demonstrates the technique for iris fixation of a dislocated IOL. An advantage of this approach is that it only requires paracentesis incisions and does not require the creation of a main incision.  A few keys to success are placing the sutures as peripheral as possible to reduce ovalizing of the pupil. Elevation of the IOL complex prior to placing the suture helps to identify the location of the haptic for suture placement. The modified Siepser slip-knot provides an excellent way to fixate the lens. Our preferred sutures are either a 9.0 prolene suture or 10.0 polyester suture. We use a 2-1-2 tie off of the suture.

Below is the original diagram of the knot as described by Osher that could be used for iris repair or iris fixation of an IOL.
Iris_Fixated_20230_knot
Format: video
References: Osher, R.  et al. Modification of the Siepser slip-knot technique. JCRS. Volume 31:6. 2005. 1098-1100
Identifier: Moran_CORE_20230
Faculty Approval by: Alan Crandall, MD

Copyright statement: Russell Swan, MD, ©2015. For further information regarding the rights to this collection, please visit: http://morancore.utah.edu/terms-of-use/