Moran CORE

Open source ophthalmology education for students, residents, fellows, healthcare workers, and clinicians. Produced by the Moran Eye Center in partnership with the Eccles Library

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Sulcus IOL Placement

HomeLens and Cataract / Surgery for Cataract

Title: Sulcus IOL Placement
Author: D. Brian Kim, MD, Professional Eye Associates, Dalton, Georgia
Date: 7/14/2016
Keywords/Main Subjects: Cataract surgery; sulcus IOL; IOL placement
Secondary CORE Category: Ophthalmic Surgery / Lens and Cataract Surgery
Diagnosis: Cataract
Brief Description: Indications and techniques for using sulcus lenses in cataract surgery are discussed. Types of lens necessary are also discussed. The technical details are illustrated through surgical videos. 
Format: video
Series: AECOS Lecture Series 2016
Identifier: Moran_CORE_23285
Copyright statement: Copyright 2017. Please see terms of use page for more information.

Marfan syndrome ectopia lentis lens extraction

Home / Ophthalmic Surgery / Lens and Cataract Surgery

Title: Marfan syndrome ectopia lentis lens extraction
Author (s): Russell Swan, MD; Alan Crandall, MD
Date: 01/01/2016
Keywords/Main Subjects: Cataract, Ectopia lentis; Marfan; Phacoemulsification; CTR; CTS
Diagnosis: Marfan’s syndrome; Ectopia lentis; Cataract

This case is from a 5 year old girl who presented to ophthalmology clinic with decreased vision in both eyes, known history of Marfan’s syndrome who was found to have bilateral subluxated natural lenses. After a long discussion with the family they elected to proceed with lens extraction and intraocular lens placement.

This video demonstrates the difficulty associated with these cases due to the diffuse zonulopathy often found. While a femto-assisted capsulorhexis could have helped in this case, the patient’s age and need for general anesthesia prevented the use of this technology at our institution. Given the age of the patient and the need for general anesthesia the decision was made to perform bilateral same day surgery.

After a capsulorhexis is initiated, capsular tension hooks are used to facilitate completion of a continuous curvilinear capsulorhexis. Gentle hydrodissection is carried out and an I/A hand piece is used to remove the crystalline lens. A capsular tension ring is placed in the capsular bag. A conjunctival peritomy is completed and then two adjacent sclerotomy sites are created with a bent 25-gauge trochar. An Ahmed capsular tension segment is threaded with 8-0 Gore-Tex and placed in the anterior chamber. Each end of the Gore-Tex is externalized through the sclerotomy sites. These capsular tension devices are utilized to secure the capsular bag to the sclera and provide support for safe intraocular lens placement. The IOL is placed in the sulcus. Once the IOL is in an appropriate position, the Gore-Tex is secured.  Given the myopic shift over time in this patient +2.0 diopters of hyperopia was targeted. Sulcus fixation was selected given that this would make potential IOL exchange easier in the future if the patient developed significant myopic shift. A 3-piece lens was thus selected as to reduce IOL related complications from the sulcus placement.

It should be noted that there are many surgical approaches to young patients with ectopia lentis related to Marfan syndrome. These include but are not limited to lensectomy with or without anterior vitrectomy, pars plana vitrectomy and lensectomy. The patient can be left aphakic, or corrected with an iris fixated IOL, anterior chamber IOL, or scleral fixated posterior chamber IOL.

Format: video
Crema, A. et al. Femtosecond Laser-assisted Cataract Surgery in Patents With marfan Syndrome and Subluxated Lens. Journal Refractive Surgery. 2015 May: 31(5): 388-41
Miraldi, U., Coussa, R., Traboulsi, E. Surgical management of lens subluxation in Marfan syndrome. Journal AAPOS. 2014 Apr: 18(2):140-6
Identifier: Moran_CORE_20240
Faculty Approval by: Alan Crandall, MD

Russell Swan, MD, ©2015. For further information regarding the rights to this collection, please visit:

Iris fixation of dislocated IOL in a patient with pseudoexfoliation

Home / Ophthalmic Surgery / Lens and Cataract Surgery

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; suture fixation 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.
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:


Suturing IOL’s

HomeLens and CataractSurgery for Cataract

Title:  Suturing Intraocular Lenses (IOL’s)
Author:  Sonya Dhar, MD
Date:  06/29/2011
Keywords/Main Subjects: Cataract; Cataract surgery; ; Intraocular Lens; IOL; Sutured IOL; Iris sutured IOL; Scleral; sutured IOL
Diagnosis: None
Brief Description: 
Format: video
Series: Moran Eye Center Grand Rounds
Identifier: Moran_CORE_16006
Copyright statement: Copyright 2015. Please see terms of use page for more information.