Decentered IOL: Exchange Or Reposition?

This patient presented approximately 3 months after phaco IOL by Dr. Else Where with elevated IOP and poor vision. The one piece PMMA lens was obviously decentered and in the sulcus with 360 degrees iris transillumination defects. Dr. Else Where had attempted repositioning this lens 3 times since the original cataract surgery without success. Once the IOP and inflammation were under better medical control I took this patient to the OR with the intention of removing the lens and replacing it with a foldable iris sutured IOL; I expected the inferior zonules were incompetent and thus the decentration. The lens was also 12mm overall length and inappropriate for sulcus fixation and if a haptic were bent his may also lead to subluxation. Fortunately a less invasive procedure was possible and the patient has done well postoperatively with well controlled IOP and a centered lens with reasonably good vision. Video by Jason Jones, MD.