Cataract surgical problem
Consultation – Feb # 11
It is clear that the described situation must be resolved. As the IOL is well centered to the optical axis of the eye, I would not explant it. Rather, I would push the optic of the IOL through a dilated pupil, which should be possible in a nontraumatic surgical procedure with a blunt spatula. Postoperatively I would try to determine whether there is a risk for a second iris capture of the IOL. Only if necessary, I would recommend pilocarpine 1% eyedrops every other night to keep the pupil slightly smaller.
If the patient does not accept the side effects of this medication and if a risk for a second iris capture is still likely, I would explant the IOL. I would loosen the polypropylene sutures under the scleral flaps or cut the PMMA haptics of the IOL from the scleral fixation. Then, I would explant the IOL through a 6.0 mm frown incision and replace it with a 6.0 mm aphakic Verisyse IOL. I would fixate the IOL in the anterior chamber in the usual manner. This IOL exchange should solve the patient's problem permanently.© 2005 by Lippincott Williams & Wilkins, Inc.