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» Long healing time and visual recovery

– In older patients may be very significant time

Replacement with AC IOL» Longer healing time

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

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

reasener

Oval pupil corrected with iridoplasty

After lens suturing and iridoplasty

Siepser knot

Why iridoplasty?

Better optics and less glare Less peripheral anterior Synecheia

» Less decrease in outflow Better tolerance of mild lens

decentration

Complications of repair

Retinal detachment Glaucoma

Corneal edema Cystoid macular edema

Recurrence of dislocations

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