Cataract surgical problem
Consultation – Feb # 4
This case is but 1 of many reported in which a previously transsclerally fixated PC IOL dislocated many years after the original placement despite the use of 10-0 polypropylene suture. The original thought that 10-0 polypropylene does not biodegrade is erroneous, as these numerous case reports prove. Some surgeons have likened this to a “time bomb waiting to happen” because it seems to be unpredictable which lenses will dislocate and which will not after transscleral fixation with 10-0 polypropylene suture. As a consequence, newer suture materials, including 9-0 polypropylene, various polyester materials, and Gore-Tex, are being investigated with the hope they will prove to be truly “life-long.”
In the case presented here, optic capture by the temporal aspect of the pupil has occurred, giving the patient a “cat's eye” appearance. This is the cause of the glare symptoms and reduced vision quality despite 20/20 acuity. Given that pharmacologic and laser attempts have failed to reposit the optic behind the pupil and in the presence of stable fixation, I would recommend using topical anesthesia and intracameral anesthesia in the operating room. I would break the synechias at the pupillary edge and gently reposit the optic behind the pupil. I would instill an intracameral miotic at the conclusion of surgery to be sure that the pupil size would be smaller than the optic. I would also check for lens tilt to reconfirm IOL positioning as significant tilting could have led to the original lens capture. The morbidity of such a minor procedure should be small, and this approach should leave the patient symptom free.© 2005 by Lippincott Williams & Wilkins, Inc.