IOL Exchange, PPV and scleral sutured PCIOL by Steven G. Safran MD

This is a 50 year old patient with Fuchs Heterochromic iridocyclitis, and glaucoma. She had cataract surgery 20 years ago and a recent trabeculectomy surgery superiorly. Her IOL is both damaged by YAG laser pitting and inferiorly disolcated with poor capsular support. A decision was made to exchange the lens and scleral fixate the new IOL with an aggressive pars plana vitrectomy done to remove significant vitreous inflammatory debris in the hope of reducing chronic inflammation and improving vision. A temporal approach was used because she had over 4 diopters of against the rule astigmatism and to avoid disturbing her filtering bleb. She was very happy with the outcome of this surgery seeing 20/25at one week post op with a very quiet eye. Please note the importance of a self sealing incision to maintain control of the eye throughout the procedure with the pars plana infusion cannula in place. Also note that a 25 guage infusion line was used with 20 guage vitrectomy with excellent fluidics througout the procedure (bottle height was at 80 during vitrectomy lowered to 40 when the vitrector was removed).

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