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It's generally necessary to remove the implant from the capsular bag because the bag has accumulated regenerating lens material" (e.g. "Unless one removes that material," he says, "there's potential for it to be liberated within the eye, potentially inducing inflammation and elevating intraocular pressure." Dr.Masket prefers to use an automated vitrector device to cut away the capsular bag and then reposition the existing lens by suturing it to the iris. Masket's increasing scale of invasiveness is sewing the existing lens to the sclera."The ophthalmologist should determine what is the underlying cause of the dislocation, and if it's likely to be progressive," Dr. In these latter cases, surgery is more elective than urgent, says Dr. IOL dislocation following trauma is a different situation, says Dr. "The patient has an injury, a certain amount of damage is done, but it tends not to be progressive," he explains.Trauma is the other side of the coin from capsule constriction and zonulysis due to pseudoexfoliation or a related disorder.You don't want to interfere with the long ciliary vessels and nerves, and it cuts down the potential for bleeding." He prefers to tie the sutures in the oblique quadrants.In cases where one haptic is well-positioned in either the sulcus or the capsule bag, and just one loop is free, Dr."If one notes significant constriction, I strongly recommend using the Nd: YAG laser to create radial relaxing incisions in the anterior capsule to reduce the effect of the centripetal fibrotic traction," he instructs.
Patients with any of these conditions should be followed carefully postop for signs that the capsule is contracting."If we can't use the existing lens and sew it to either the iris or the eyewall, then that lens must come out," Dr. Removal may be necessary if the haptics are severely damaged or have separated from the optic.Furthermore, some IOLs are not well-suited for suturing to either the iris or the sclera, such as one-piece Acry Sof IOLs. "Most eyes with problems of this nature tend to be already compromised," he explains.Masket says that it's worth considering closely the details of each case before proceeding."The needs of each case should be measured individually and surgery or non-surgical treatment applied as appropriate," he says.
"[Anterior segment surgeons] often don't have the tools such as the microforceps to go through small sclerotomies, capture the loop, fix the suture to it and then sew it to the eye wall," says Dr. Nevertheless, the lasso method, which can be employed by surgeons in either camp, works well for fixating IOL loops or capsular tension rings to the sclera.