Anterior-assisted levitation for the posteriorly dislocated intraocular lens

I describe a technique to manage a subluxated crystalline lens or an in-the-bag posterior chamber intraocular lens (PC IOL) that tilts severely into the anterior or midvitreous cavity. In the absence of intervening vitreous presentation, a 27-gauge needle is inserted via a snugly fitting paracentesis incision to reach the anterior capsule of the posteriorly dislocated cataract or the anterior capsulorhexis rim of the PC IOL without disturbing the anterior chamber stability. With the bevel facing forward, the needle is introduced at an oblique angle and used to gently puncture the anterior capsule of the subluxated lens or insinuate between the fibrosed capsulorhexis rim and the optic of the subluxated PC IOL. The needle tip is brought forward and the anterior capsule grasped by microforceps introduced via another paracentesis wound. An ophthalmic viscosurgical device is then injected into the anterior chamber and the lens stabilized.