Complicated cataract surgery: Explanting two IOLs

This is a video shared by Dr. Prashant Kumar from New Delhi – India

In this video, the surgeon shows a pars plana vitrectomy performed to remove two IOLs dislocated to the vitreous cavity after complicated cataract surgery. After placing the trocars, and before starting core vitrectomy, it is important to perform anterior vitrectomy to remove all the vitreous from the pupillary plane.
In this case, there wasn’t adequate capsular support to implant or reposition the IOL in the ciliary sulcus. So the surgeon decided only to remove both dislocated IOL and to program a secondary implant in another procedure.
In the beginning of the vitrectomy, the core vitreous and areas of vitreous hemorrhage are removed, and triamcinolone was used to help in the PVD induction maneuver.
All the vitreous is removed from the IOL body, and before dragging the IOL to the anterior chamber, the vitreous base needs to be shaved to avoid iatrogenic retinal breaks.

After removing the vitreous, the surgeon uses two retinal forceps to bring the IOL anteriorly and remove by an enlarged corneal incision. If an IOL is implanted in the ciliary sulcus and another one is still in the vitreous cavity, it will be more difficult for the retinal surgeon to remove the dropped IOL since the anterior chamber removal technique will be unavailable. A large scleral tunnel with greater risks related to hypotony would have been necessary if the IOL had been in the sulcus. Therefore, in cases of complicated cataract surgery, with the IOL dislocated to the vitreous cavity, do not try to place a second IOL in the same procedure.
In this case, once both IOLs were in the vitreous cavity the surgeon could remove it through the anterior chamber.
In the end of the surgery, nylon sutures are made in the corneal incision. Then fluid air exchange and sclerotomies sutures are performed.

Prashant Kumar MD 🇮🇳

Filipe Lucatto MD
Juliana Prazeres MD
Salvador 🇧🇷