Small-gauge vitreoretinal instrumentation can be used for scleral fixation of IOLs

Numerous innovative techniques have been developed for addressing dislocated IOLs in eyes without sufficient capsular support. Maggi and colleagues were one of the first to introduce the concept of sutureless scleral fixation of an IOL. Recently, the implementation of vitreoretinal surgical instrumentation to assist with IOL fixation has gained popularity.Indeed, the advantages of smaller-gauge vitreoretinal instrumentation have fostered the development of numerous surgical techniques and novel applications in cases involving a dislocated IOL in eyes without sufficient capsular support. These techniques involve cannula-based sutureless intrascleral fixation or sutured scleral fixation. In some cases in which the dislocated IOL is not damaged, IOL rescue with repositioning and scleral fixation may be more desirable than IOL exchange. In other cases, IOL explantation and scleral fixation of a new IOL may be desirable. I describe a simple and minimally invasive approach using 27-gauge vitreoretinal instrumentation for cases in which IOL exchange with scleral fixation is desirable.