“Stay Back Technique” of scleral fixation of decentred intraocular lens-bag complex

BACKGROUND: Even though rare, posterior chamber intraocular lens (IOL)-bag complex dislocation is a serious complication following cataract surgery. Preoperative trauma or zonular weakness, capsule contraction syndrome, and surgical or postoperative trauma to the zonules have been proposed as the causative mechanism. Various risk factors have been described such as pseudoexfoliation (PXF), aging, high myopia, uveitis, trauma, previous vitreoretinal surgery, retinitis pigmentosa, diabetes mellitus, and connective tissue disorders, among which PXF is the most common risk factor. The management of late IOL-bag complex dislocation poses a challenge even for an experienced surgeon. PURPOSE: To demonstrate the “stay back technique” of scleral fixation of decentered IOL-bag complex. SYNOPSIS: We demonstrate three cases of scleral fixation of anteriorly dislocated IOL-bag complex. The first two cases are traumatic subluxation of IOL-bag complex and the third case is late decentration of both the haptics in a case of PXF. A scleral flap/groove is made along the area of haptic dislocation. Dislocated haptic is allowed to stay in the same position and one arm of 9-0 prolene suture is passed between the optic-haptic junction and docked in a 26-gauge needle passed beneath the scleral flap, 2 mm from the limbus. Haptic is then repositioned beneath the iris and the second arm of prolene suture is passed above the haptic. Sutures are pulled underneath the scleral flap and secured with 5 to 6 knots. HIGHLIGHTS: This is a simplified approach of scleral fixation of anteriorly dislocated IOL-bag complex. This novel technique gives better visualization of the optic-haptic junction during the passage of prolene suture. ONLINE VIDEO LINK: https://youtu.be/vKQCR0fow68