This patient was referred to me with an inferiorly subluxated IOL.
After considering all surgical options, I removed their subluxated IOL and sutured a 3-piece lens to the posterior surface of their iris.
This patient has severe pseudo-exfoliation syndrome, revealed by the florid PXF material at the pupil margin.
This patient’s existing lens wasn’t suitable for suture fixation, therefore I explanted it. Now I need to choose a technique for fixating a new lens into their eye!..
I sutured a new lens to their iris as this approach SPARES their drainage angle and SPARES their conjunctiva. This is important, because given the severe PXF, this eye is at high risk of needing glaucoma filtration surgery in the future. Especially after the stress and steroids of a lens exchange! :)
I want to spare this patient’s conjunctiva, as the patient will likely need it for future glaucoma surgeries.
I can iris-suture an IOL without even touching the patient’s conjunctiva, or their drainage angle. It’s an elegant approach. IOLs fixated to the iris have also been shown to be incredibly well tolerated by the eye, even though it seems counterintuitive.
Below were my alternative IOL options:
I’m very fortunate to have been formally trained in the techniques for lens exchanges. This gives me lots of treatment options when planning a patient’s surgery. Given the multitude of surgical techniques, each with its own advantages and limitations, I now find IOL exchanges and secondary IOLs one of the most interesting and complex areas of my work.