Management of a dislocated 3-piece intraocular lens with an iris prosthesis in situ

A 33-year-old man with a past injury of the left eye involving iris loss and choroidal rupture in 2002, presented with 1-month history of spontaneous blurry vision. On examination he had a dislocated 3-piece Ophtec (Netherlands) intraocular lens (IOL) in the vitreous with an iris prosthesis (Human Optics, Germany) dislocation sutured at 9:00 o'clock and poorly attached at 3:00 o'clock (Supplementary Video 1). The already kinked IOL was cut and explanted (A), and a secondary IOL inserted and fixated to the sclera behind the iris prosthesis using a Yamane technique (B). The iris prosthesis was subsequently refixated to the sclera with a double-flanged 5-0 prolene suture by feeding it through the bevel of the needle (similar to feeding a haptic into the needle during the IOL fixation) (C). The conjunctiva was cut to uncover the triangular flap created from the previous surgery, remove any residual prolene that may have been left and use the already created flap. The iris prosthesis was refixated to the sclera in an additional location. The case concluded with a well-positioned 3-piece scleral-fixated IOL and a fixated iris prosthesis (D). Postoperatively, the visual acuity was 20/250 owing to preexisting traumatic maculopathy. The patient also developed steroid-response glaucoma, which was managed with steroid taper and topical medications.