A now 40-year-old man had cataract surgery complicated by capsule rupture and posterior intraocular lens (IOL) dislocation at age 29 years. Eventually, it was necessary to perform a vitrectomy, retrieve and remove the IOL from the posterior segment, and suture a poly(methyl methacrylate) (PMMA) posterior chamber (PC) IOL to the sclera. According to the reports, an Alcon CZ70 IOL was sewn to the sclera under flaps using 10-0 polypropylene suture material, which was affixed to the haptic eyelets. The patient did well for a decade, during which time the fellow eye had uneventful phacoemulsification with in-the-bag IOL placement, and he continues to function normally.
After 10 years, 1 of the 10-0 polypropylene IOL sutures degraded and the nasal loop of the lens became mobile, inducing fluctuating vision and significant IOL tilt. During corrective surgery, both loops were suture fixated to the sclera with 9-0 polypropylene in a lasso fashion and the problem seemed to be ameliorated.
Now, 1 year later, the patient reports a sudden onset of glare symptoms and reduced vision quality, although the best corrected visual acuity (BCVA) remains 20/20 and the intraocular pressure is well within normal range. He denies meaningful trauma or unusual eye rubbing. As seen in the clinical photograph (Figure 1), the patient has developed pupil capture of the temporal aspect of the IOL. The IOL is immobile, both loops appear stable, and the suture loops appear intact under the conjunctiva, which is heavily scarred from previous surgery. Posterior segment examination is fully normal. Pharmacologic and laser attempts to reposit the optic behind the pupil have failed.
What is the best course of management?