Minimally invasive relocation of subluxated single piece IOL

A single piece AcrySof IOL could be subluxated due to an unrecognized capsular tear prior to implantation, willful implantation of the IOL despite a capsular tear or inherent weakness of the zonules.
Single piece AcrySof IOLs, when placed in the ciliary sulcus, without scleral fixation, were explanted and exchanged because of pigment dispersion, pigmentary glaucoma, uveitis, Iris chafing etc.1 IOL explantation and exchange with scleral fixation requires a larger incision, is traumatic to the cornea and iris and involves greater risk of vitreous loss, postoperative astigmatism and endophthalmitis. Secondary implantation by transcleral suture fixation of a one-piece foldable, AcrySof IOL through clear corneal incision has been reported to be a reasonable technique.2, 3 Hence, the possibility of repositioning the same IOL safely and securely by a minimally invasive technique must be explored.

Surgical Technique
The sclera is bared in diametrically opposite areas and two 2mm x 2mm rectangular scleral flaps are made 1mm posterior to the surgical limbus. The original paracentesis are gently opened with a 1mm spatula or two paracentesis are made 4 clock hours apart. The anterior chamber is filled with OVD. The subluxated IOL is brought into the anterior chamber bimanually using a Hirschman hook and a spatula. Bimanual anterior vitrectomy is performed through the paracentesis to free the anterior chamber, pupillary area and anterior vitreous space of capsular remnants and vitreous strands.