Supracapsular glued IOL in progressive subluxated cataract maintains intact vitreous face

Progressive causes of zonular dehiscence may be associated with late subluxations and dislocations of the IOL. The general strategies to avoid this include either two- or three-point fixation of the capsular bag during primary surgery even in lesser degrees of subluxations or a lensectomy with anterior vitrectomy and scleral/iris fixation of the IOL. The latter leads to anterior hyaloid face and vitreous disturbance with consequent disadvantages.One of the authors (Jacob) described a technique in 2013 (https://www.youtube.com/watch?v=jpkMsVaDvnA) for supracapsular fixation of a glued IOL in order to retain an intact anterior hyaloid face and avoid disturbance of the vitreous while at the same time providing stable long-term fixation of the IOL. This is for patients with a progressive zonular pathology in which the bag is not hugely decentered. This includes progressive causes of subluxation such as pseudoexfoliation, megalophthalmos, high myopia, aniridia, Marfan syndrome and homocystinuria — cases in which, despite in-the-bag IOL with scleral fixation using a capsular tension ring or segment at the time of the first surgery, progressive zonular dialysis can cause a subluxation from a different quadrant.