Author: Yassine Malek (Morocco)
Co-authors: Taoufik Abdellaoui, Said Chatoui, Shamil Louaya, Karim Reda, Abdelbarre Oubaaz
To describe the technique and the steps needed for safe explantation of a total dislocated PMMA lens into the vitreous cavity after ocular trauma.
Ophthalmology Department, Agadir Military Hospital, Agadir, Morocco.
In this video, we describe the case of a 68-year-old man, who underwent ECCE surgery 25 years ago and came to the ophthalmology department emergencies for postraumatic vision loss. Slit-lamp examination revealed ruptured capsular bag with no sulcus support. Dilated fundus examination showed a totally luxated IOL into the vitreous cavity, laying on the retina. Peripheral retinal examination reveal no breaks or retinal detachment. Decision was made to perform vitrectomy and explantation of the PMMA lens with secondary iris-claw lens.
The patient underwent under sub-tenon anesthesia, a 23-gauge 3 ports pars-plana vitrectomy. First, an anterior vitrectomy was done, followed by a posterior vitrectomy with 360 degrees liberation of vitreous adherences to the IOL, until it became fully mobile in the vitreous cavity . Then, Peripheral vitrectomy was made. Remnants of capsular bag were cut with vitrectomy probe. A 23 gauge micro forceps was used to grab one of the PMMA lens Haptics into the anterior chamber, then a bimanual technic was used with a second 23 gauge micro forceps introduced from the limbus, grasping the other haptic and taking it off the incision outside the anterior chamber permitting its stabilization without further grasping. A 6 mm limbal keratotomy was done using curved katzin scissors, following the scar of the old ECCE incision. The PMMA was explanted true the keratotomy and 10.0 Nylon interrupted sutures were done. Patient was scheduled for secondary iris-claw lens fixation.
Explantation of a dislocated PMMA lens into the vitreous can be quite challenging and requires certain dexterity. However scleral tunnel should be preferred to corneal incision for PMMA lens explantation due to less induced astigmatism and self-sealing incision.
I have no financial interest