“However, if the patient has had a previous vitrectomy, the lens can drop very quickly. Hoffman, MD, a clinical associate professor of ophthalmology at the Casey Eye Institute, Oregon Health and Science University, and a partner at Drs. “Most of the time, you have several weeks or even months to repair a case of pseudophakodonesis with an IOL/capsular bag complex,” says Richard S. In terms of timing, factor in whether the patient has had a previous vitrectomy.Surgeons suggest considering a number of factors when faced with a lens that needs fixation: If it’s just sitting under the conjunctiva (above, left), the result can be exposure and breakage of the sutures and a dislocated IOL (right). When suturing a lens in place, it’s important to make sure that the suture material (most commonly Gore-Tex) is buried within the sclera. Here, eight surgeons discuss the pros and cons of the most popular IOL fixation techniques, and offer pearls for making the procedures go smoothly and produce the best outcomes. Is one fixation technique better than another? Even retrospective studies have rarely compared techniques directly, but a 2020 assessment made by the American Academy of Ophthalmology reviewed 45 relevant studies and found that no technique has proven itself superior to the alternatives. The lens may be sutured to the iris, or even replaced with an anterior chamber lens, but often the lens is fixated to the sclera using one of a number of popular techniques. Sometimes remedying (or preventing) that requires fixating the current or replacement lens in position. A lthough it’s relatively rare, IOLs can sometimes become dislocated, usually because of the absence of zonular support.
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