Surgery: Secondary Sulcus Fixated IOL Implantation

This video demonstrates a secondary IOl implantation in an 8-year-old girl who presented with aphakia. The membrane was removed and an IOL was implanted in the sulcus.

Surgery Location: on-board the Orbis Flying Eye Hospital, Mandalay, Myanmar
Surgeon: Dr. Ramesh Kekunnaya, L V Prasad Eye Institute, Hyderabad, India


This patient is an 8-year-old girl. She underwent cataract when she was very young. Her best corrected visual acuity is 20/80 in both eyes, with aphakic glasses. So here what we are trying to do is we are gonna take out this membrane. You can see the size of this membrane. This is quite large. So we are going to do the sulcus fixated lens in this particular patient. One of the questions most of the people ask is: Where do you place this incision? Whether to go to the old one or try to create a new one. I generally try to create a new one, because the old one is already fibrotic. So that’s the nick there. I need a capsulorrhexis forceps. You can see there’s some plaque-like material there. So we will use a little bit of vitrector to open it. Look at the direction of the probe. Changing all the time. This is like a normal posterior capsule. I can see the denser part here. This is much more dense than this part, what I opened now. If I take out this densest part, then the opening is too big. The support of the lens may not be good. The lens epithelial cells are there. But they’re not, again, dense. We can cut that, but it’s not safe to do that in this case, because it will go beyond the size of your second IOL, and as I’m injecting, the anterior chamber is becoming deep, and also, you have a dilatation of the pupil. You can see that dense capsule part is bowing down now. So we are going to implant an MS-60 lens here. So a little bit of a tight wound, especially what happens is — whenever there is a second IOL, there can be a problem. It may not open so easily. So yeah, I’m facing this way now. You can see the haptic coming there. As it is coming, you can just turn it up a little bit. A little bit up. And you can come out. You can see there is some piece of haptic. We need to see from where it has come. Plenty of haptic is there. So you can just go in, just beneath, without touching the iris. And if you need some more dialing, you can inject viscoelastic. You can see this part is going in, and as it is going in, we need to pull this part, and make sure that it’s in the center. Whenever you are implanting in the sulcus, always it’s best to use a little bit of pilocarpine or Miochol at the end of the surgery. In this case, I’m going to go behind the IOL and make that opening a little bit bigger. And I’m going to inject Miochol to constrict the pupil, and obviously I’m going to place one suture for the main wound. I think your medication is standard. Vigamox four times. Prednisolone six times. And one dilating drop. And I would consider that putting a drop of Miochol is very, very important. And we had an amputated haptic. Probably it’s very well centered. Otherwise I would have taken out this lens and put another lens.

3D Version

January 1, 2020

Last Updated: October 31, 2022

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