Ashvin Agarwal, MD, focuses his blog on interesting cases and experiences he encounters as an anterior segment surgeon.

SURGICAL VIDEO: How to handle complex subluxated IOL case

This video describes the management of a subluxated single-piece rigid IOL, Soemmering ring and high IOP. To treat this, we have planned to do a trabeculectomy and refix the same IOL with a glued IOL. A vitrector is used to release the synechiae and dislodge the Soemmering ring, and then it is brought above the IOL optic so as to effectively compartmentalize the anterior and posterior chamber, thus making the scaffold ineffective and, as a result, the pieces sink into the vitreous cavity. The haptics are externalized and then tucked into the scleral pockets. Single-pass four-throw pupilloplasty is performed to avoid optic capture due to the lack of anterior capsular rim. Trabeculectomy is performed for the high IOP, and the case is closed.