Modified double-flanged technique in the management of dislocated posterior intraocular lenses

To evaluate the modified double-flanged technique in cases of subluxated foldable single-piece intraocular lenses (IOLs).

This retrospective study was conducted on 14 eyes of 14 patients.The following steps were performed in the surgical technique, respectively;the dislocated foldable single-piece IOL was repositioned into the anterior chamber, and the haptic was extracted through the corneal main incision.A 27-gauge needle was passed through the widest part of the haptic, close to the haptic-optic junction.A 6.0 polypropylene suture was passed through the needle. For the same process on the other haptic, the IOL was rotated 180 degrees.The polypropylene part of the created haptic-polypropylene complex was extracted through the scleral tunnel using a 26-gauge needle as a guide. The 1.5 mm tips of the polypropylene were cauterized to form flanges, which were then embedded into the sclera. The preoperative and postoperative first and sixth month ophthalmological findings were evaluated.

Both uncorrected visual acuity and best-corrected visual acuity were significantly higher at the postoperative sixth-month follow-up(p < 0.001).Possible causes of IOL subluxation; were pseudoexfoliation in five patients (36%),complicated cataract surgery in three patients (21%),trauma in two patients (14%) and no cause was found in four patients (29%). Of the 28 flanges, 24 (86%) were located intrasclerally, while four (14%) were in the subtenon space.Elevated intraocular pressure was detected in one case (7%) in the early postoperative period, and cystoid macular edema was noted in two cases (14%).

This study demonstrated that the modified double-flanged technique could be effectively and safely applied in cases of subluxated foldable single-piece IOL.