Bimanual intravitreal capsular bag peeling for posteriorly dislocated bag-intraocular lens complex

Amber A Bhayana; Pradeep Venkatesh; PR Ananya; Shorya V Azad; Priyanka Prasad

doi:10.4103/ijo.IJO_608_22

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Year : 2022 | Volume : 2 | Issue : 3 | Page : 816-817

Bimanual intravitreal capsular bag peeling for posteriorly dislocated bag-intraocular lens complex

Amber A Bhayana, Pradeep Venkatesh, PR Ananya, Shorya V Azad, Priyanka Prasad
Department of Ophthalmology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, New Delhi, India

Date of Submission	06-Mar-2022
Date of Acceptance	23-Mar-2022
Date of Web Publication	16-Jul-2022

Correspondence Address:
Dr. Pradeep Venkatesh
Dr R P Centre, AIIMS, New Delhi - 110 029
India

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijo.IJO_608_22

Abstract

Keywords: Bimanual, capsular peeling, dislocated bag-IOL complex, vitrectomy

How to cite this article:
Bhayana AA, Venkatesh P, Ananya P R, Azad SV, Prasad P. Bimanual intravitreal capsular bag peeling for posteriorly dislocated bag-intraocular lens complex. Indian J Ophthalmol Case Rep 2022;2:816-7

How to cite this URL:
Bhayana AA, Venkatesh P, Ananya P R, Azad SV, Prasad P. Bimanual intravitreal capsular bag peeling for posteriorly dislocated bag-intraocular lens complex. Indian J Ophthalmol Case Rep [serial online] 2022 [cited 2022 Aug 11];2:816-7. Available from: https://www.ijoreports.in/text.asp?2022/2/3/816/351205

A 45-year-old otherwise healthy female was planned for pars plana vitrectomy for posteriorly dislocated intraocular lens (IOL). The subject had a 3-piece IOL inside the bag with the bag-IOL complex posteriorly dislocated [Figure 1]a. We planned to fixate the same IOL trans-sclerally for which we needed the haptics free out of the capsular bag. We devised a novel technique for the same. After adequate vitrectomy,^[1] Chandelier-assisted bimanual peeling of the capsular bag off the IOL was done using two 25-gauge intravitreal forceps [Figure 1]b. The IOL was held in mid-vitreous cavity with one forceps and capsular bag peeled with the other [[Figure 1]c and [Figure 1]d, Video 1]

. After the IOL was free (retina protected with perfluorocarbon liquid (PFCL)- [Figure 1]e), the bag remnants were eaten up with vitrector. The same IOL was then fixed onto and through the sclera [Figure 1]f.

Figure 1: (a) Vitrectomy in progress- posteriorly dislocated bag-IOL complex visible; (b) use of two microforceps; (c) capsular bag peeling in progress; (d) capsular bag peeling complete and IOL free; (e) bag eaten with vitrector-PFCL in situ; (f) the same IOL fixed transsclerally

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Discussion

In usual scenarios, it is a single-piece IOL that finds its place inside the capsular bag. If such bag IOL complexes are posteriorly dislocated, they are explanted in toto. Refractive rehabilitation can be provided by an anterior chamber IOL, iris-claw lens, or scleral fixation IOL. A posteriorly dislocated single-piece IOL can be fixed to the sclera by using polypropylene sutures. When a 3-piece IOL finds its way into the posterior segment, it is usually bare and originates from an inadequate scleral sulcus where it was previously placed or a failed scleral fixation. Because haptics in these cases is bare, they can be fixated or refixated to the sclera.^[2] Our case was unique in the fact that we had a 3-piece IOL inside the bag which was posteriorly dislocated. We freed it off the capsule with bimanual manipulation and proceeded with a normal scleral fixation.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1.	Sella S, Rubowitz A, Sheen-Ophir S, Ferencz JR, Assia EI, Ton Y. Pars plana vitrectomy for posteriorly dislocated intraocular lenses: Risk factors and surgical approach. Int Ophthalmol 2021;41:221-9.
2.	Erakgun T. Intravitreal needle technique for intrascleral haptic fixation of posteriorly dislocated three-piece intraocular lenses. Retin Cases Brief Rep 2020. doi: 10.1097/ICB.0000000000001102. Online ahead of print.