This is a good example of long-term follow-up of a scleral fixated IOL. The IOL was refixated to the sclera by 2 sutures of 9-0 polypropylene 1 year ago. The IOL seems to be well positioned with both loops stable, although there is no pupil capture.
As the pharmacologic and laser attempts were not able to maintain the optics behind the pupil, 2 procedures can be considered. One is to press the optic posteriorly with a cannula, followed by injection of a miotic through a limbal paracentesis. The miotic drops would be maintained for 2 to 3 weeks to prevent recurrence. This would be my first choice in this case.
The second option is to perform iris fixation of the lens haptics with a McCannel suture technique. I normally prefer iris fixation instead of scleral fixation in cases of aphakia secondary IOL implantation, posterior segment IOL dislocation, or a malpositioned lens.
I have been performing iris fixation of a 3-piece MA60 AcrySof IOL in patients with zonular weakness such as in cases of Marfan's syndrome with no complications. In 1 case of Weil-Marchesani syndrome, the patient developed pupil capture of the temporal side of IOL after ocular trauma. The problem was solved by pressing the lens back through a temporal paracentesis with a 26-gauge needle at the slitlamp.
Thus, in this case, I believe the first option would work well.