Laser of the Haptic-Optic Junction to Fix a Tilted Yamane Intrascleral-Fixated Lens

Abstract

Purpose: To report a case of tilted sutureless intrascleral fixated IOL, emphasizing its management with 23-gauge laser to strengthen the haptic-optic junction. Methods: Case report. Results: A 27-year-old man was referred for treatment of traumatic cataracts in his left eye. He underwent pars plana vitrectomy, lensectomy, membrane peel, and capsulectomy without complications. Five days after the surgery, he developed ocular hypertension that ultimately required insertion of an Ahmed glaucoma valve in the left eye. 16 months after the initial procedure, the patient underwent secondary lens implantation with a CT Lucia 602 IOL in the left eye using the Yamane technique. The day following surgery, the patient presented with a significantly tilted lens. Three weeks later, the patient underwent surgery for IOL repositioning. The manipulation of the haptics was ineffective in repositioning the IOL. The temporal sclerotomy was removed and a 23-gauge probe was used to laser both optic-haptic junctions while a light pipe held the lens in place. The tilt was corrected, and visual acuity improved to 20/40 at one year follow-up. Conclusions: Successful repositioning of tilted sutureless intrascleral fixated IOLs can be achieved using 23-gauge laser reinforcement at the haptic-optic junction. Consideration could be made to perform this laser at the time of implantation as a prophylactic approach to mitigate tilt and reduce the risk of reoperation.