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Why reposition and suture instead of replace

90 y o, 20 y after cataract surgery, 3 y after suturing of left eye, 20/400 preop, 20/40 post op, removal retained lens material. Why reposition and suture instead of replace. Replacement with large one piece PMMA sclerally sutured IOL Requires large incision

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Why reposition and suture instead of replace

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  1. 90 y o, 20 y after cataract surgery, 3 y after suturing of left eye, 20/400 preop, 20/40 post op, removal retained lens material

  2. Why reposition and suture instead of replace • Replacement with large one piece PMMA sclerally sutured IOL • Requires large incision • Long healing time and visual recovery • In older patients may be very significant time • Replacement with AC IOL • Longer healing time

  3. dislocation after complicated cataract surgery in patient with NAG s/p PI OU, 20/200 preop, 20/50 post op fixation, secondary BK, 20/40 after DSEK

  4. B, 70 y o Dsek 2007, lens sutured 2 years later, +cme

  5. reasener

  6. Oval pupil corrected with iridoplasty

  7. After lens suturing and iridoplasty

  8. Siepser knot

  9. Why iridoplasty? • Better optics and less glare • Less peripheral anterior Synecheia • Less decrease in outflow • Better tolerance of mild lens decentration

  10. Complications of repair • Retinal detachment • Glaucoma • Corneal edema • Cystoid macular edema • Recurrence of dislocations

  11. Dislocated IOLs • A problem? YES • When to treat: • Prevention: larger capsulotomies, • Capsular tension rings? • When lens causing symptoms or likely to sublux • Surgical options • With appropriate repair outcomes are excellent and recurrences are rare • The least invasive procedure is the best, iris suturing leads to consistent excellent results

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