To evaluate the intraocular lens (IOL) position after scleral suture fixation using ultrasound biomicroscopy (UBM), assess the value of the technique, and recommend ways of improving outcomes. This observational, cross-sectional study was conducted at a university eye hospital in Fudan, China from 2023 to 2025. UBM examinations were performed on patients undergoing scleral-sutured IOL fixation for IOL dislocation, aphakia, or crystalline lens dislocation. In each eye, central crossing scans and additional scans in eight directions were obtained and analysed. Image analysis focused on IOL haptic positioning (4-grade classification system), ciliary sulcus visibility, anterior segment parameters and overall IOL positioning (IOL tilt/decentration, Image-Pro Plus software). Nonparametric statistics analysed outcome correlations (SPSS v20.0, P < 0.05 significance). UBM examinations were performed on 65 eyes from 64 patients. High-quality images of the anterior segments were acquired in all eyes, clearly visualising the optics/haptics of the IOL, peripheral anterior synechiae, residual membrane proliferation and adhesion, and iris concavity. The analysis showed that 57.69% of the haptics were positioned within the ciliary sulcus, and in 520 images of 65 eyes, the sulcus was found in 303 images (58.27%). The haptic was asymmetrically placed in 33 eyes (50.77%). Multiple linear regression showed that haptic location discrepancy was associated with increased IOL vertical tilt (β = 1.72; 95% CI 0.65-2.79; P = 0.002), while axial length correlated with horizontal decentration (r = 0.37, P = 0.011). UBM is a valuable tool for assessing anterior segment conditions following IOL scleral fixation. Asymmetric haptic placement significantly increases IOL tilt, while longer axial length predicts horizontal decentration. These quantifiable parameters should inform both surgical technique selection and postoperative monitoring protocols.

Late intraocular lens dislocation arises from two independent biomechanical pathways: Structural failure and interface fatigue

To compare the short-term and long-term visual and refractive outcomes between flanged intrascleral haptic fixation (FIHF) and 2-point transscleral polymethylmethacrylate (PMMA) intraocular lens (IOL) fixation using Gore-Tex sutures in patients lacking capsular support. National Cheng Kung University Hospital, a tertiary referral center in Tainan, Taiwan. Retrospective cohort study using propensity score matching to minimize baseline differences between groups. Medical records of adult patients who underwent FIHF or Gore-Tex sutured IOL fixation between 2014 and 2024 were reviewed. Patients with <12 months follow-up or conditions affecting visual prognosis were excluded. Postoperative corrected distance visual acuity (CDVA), refractive cylinder, and complications were analyzed. A total of 92 eyes (46 FIHF, 36 sutured) were identified; after matching, 34 eyes in each group were analyzed. After matching, the FIHF group demonstrated significantly better CDVA than the sutured IOL group at 1 month (mean logMAR, 0.73 vs. 1.08; p = 0.003) and 3 months (0.62 vs. 0.94; p = 0.009) postoperatively. Cylindrical power at 3 months was significantly lower in the FIHF group (1.94 vs. 3.69 diopter, p = 0.009), indicating less surgically induced astigmatism. No significant differences were observed in CDVA, complication rates or refractive outcomes at 12 months. FIHF may facilitate earlier reduction in astigmatism, thereby promoting faster visual recovery, particularly in cases of IOL subluxation or dislocation, compared with sutured IOL fixation. However, no significant differences were observed between the two groups in terms of visual acuity, refractive status, or complication rates at one year postoperatively.

Aim: To develop an updated and refined classification of pseudoexfoliation syndrome (PEX) in the context of its complication by pseudoexfoliation glaucoma (PEXG), taking into account the current understanding of the morphological and clinical criteria of PEX and its treatment methods. Materials and Methods: The study analyzed and systematized the scientific publications regarding the modern understanding of PEX and PEXG from PubMed and Scopus databases. The publications analyzed mainly for the period 2015-2024 concerned existing classifications of PEX, as well as descriptions of PEX and PEXG symptoms, and surgical methods of their treatment. Analytical and bibliographic methods were employed. Conclusions: A comprehensive approach is required for the clear identification of PEX signs and early diagnosis of PEXG. Involvement of all tissues of the anterior segment leads to a range of intraocular complications that are significant for the treatment strategy. PEX is not designated as a separate nosological entity in the International Classification of Diseases; however, several classifications of PEX exist, none of which are used in practice. We propose an original classification of PEX that takes into account morphological and clinical changes of the anterior segment of the eye (the pattern of pseudoexfoliative material distribution, pupil diameter, degree of iridodonesis and phacodonesis, presence of lens or intraocular lens dislocation) and simultaneously implies the appropriate surgical intervention. Careful monitoring of PEX symptoms is necessary to prevent complications and to ensure timely initiation of appropriate medical and surgical glaucoma treatment, taking into account the risk of operative complications. The developed, modern, improved classification of PEX can be used in the training and clinical practice of ophthalmologists.

To describe clinical features, risk factors and outcomes of out-of-the-bag (OTB) intraocular lens (IOL) dislocation in dead bag syndrome (DBS). Retrospective review of a single-surgeon series of eyes with IOLs that developed OTB IOL dislocation, managed at Singapore National Eye Centre (January 2014-December 2021), with a minimum of 6 months of follow-up. Eyes with OTB IOL dislocation following secondary IOL implantation and intraoperative capsule complications were excluded. Patient demographics, ocular history, clinical findings, ocular trauma/eye rubbing, surgical procedures and postoperative outcomes were obtained. Fifty eyes (40 unilateral, 5 bilateral) of 45 patients were included. Patients were predominantly male (82.2%), presenting at 61.9 ± 14.1 years old, 11.2 ± 6.0 years after cataract surgery. Eye rubbing was the only form of ocular trauma (n = 34; 68.0%). Compared to non-eye rubbers, eye rubbers were significantly more likely to have elevated intraocular pressure (IOP) (32.4% vs. 6.2%; OR 10.9, 95% confidence interval [CI] 1.12-107; p = 0.040), larger posterior capsule defects (median 60% vs. 50%; p = 0.029), vitreous in the anterior chamber (38.2% vs. 6.2%; OR 10.3, 95% CI 1.05-101; p = 0.045) and lower endothelial cell counts than the non-affected eye (-145 ± 507 vs. 315 ± 639 cells/mm2; p = 0.026). The most common complications after IOL exchange were elevated IOP (n = 11; 22.0%) including glaucoma (n = 8; 16.0%) and recurrent IOL subluxation (n = 7; 14.0%). Eye rubbing appears to play an important role in the development of OTB IOL dislocations in DBS and is associated with more severe clinical manifestations. Treating the underlying cause and counselling patients to avoid or minimise eye rubbing may reduce this complication.

Two-Year Visual, Refractive, and Anatomical Outcomes of Sutureless, Intrascleral, 1-Piece Intraocular Lens Fixation: A Prospective Study.

The uveitis-glaucoma-hyphema (UGH) syndrome, initially described in 1978, presents as an iatrogenic complication associated with contact between intraocular implant and ocular tissue. This syndrome encompasses a spectrum of clinical manifestations, including intraocular inflammation, elevated intraocular pressure, and recurrent hemorrhage. Advances in cataract surgery techniques reduced the incidence of early intraocular lens (IOL) dislocation while inversely increased rates of delayed dislocation. The primary etiology of UGH syndrome is IOL subluxation. Weakness of the ciliary zonules or unstable IOL fixation techniques may predispose the eye to iris-lens contact. Other contributing factors include Soemmering's ring formation, abnormal iris and ciliary body anatomy, positional changes, and improper positioning of glaucoma implants. Clinical examination and imaging modalities such as ultrasound biomicroscopy and anterior segment optical coherence tomography supports diagnosis of UGH. Treatment options range from observation and medical therapies to invasive procedures such as laser therapy, IOL repositioning, or replacement. Endoscopy provides direct visualization for identifying causes intraoperatively, aiding in tailored surgical approaches towards minimal intervention. In conclusion, UGH syndrome poses a complex clinical challenge, emphasizing the importance of understanding its etiology, accurate diagnosis, and personalized management strategies to mitigate its impact on visual function and ensure favorable outcomes.

To assess the 1-month outcomes of visual performance and positional stability of capsule-fixated intraocular lenses (IOLs) in patients with IOL-Bag complex dislocation. We enrolled 36 eyes (34 patients) with IOL-Bag complex dislocation due to pseudoexfoliation syndrome. Patients with intraoperative complications or prior posterior capsule Nd-YAG laser were excluded. Surgical intervention involved creating a superior service keratotomy and using introflective sutures for IOL fixation. Best Corrected Visual acuity (BCVA), endothelial cell counts, and tonometry were assessed at multiple postoperative time points. We also evaluated the mean spherical equivalent (SE), and the residual cylinder and sphere at each follow-up. This study has been successfully registered on ClinicalTrials.gov public (Identifier NCT06423079). The study included 36 eyes, with 22 having a one-piece IOL, 2 with a one-piece IOL plus capsular tension ring, and 12 with a three-piece IOL. Our technique demonstrates a statistically significant improvement in BCVA 1year after surgery compared to BCVA at the time of IOL dislocation (preoperative BCVA 1.45 ± 0.81 vs 1year 0.06 ± 0.09 logMAR; p < 0.001). There were no statistically significant differences when comparing the BCVA before the IOL dislocation with the 1-year post-operative BCVA (p > 0.13). No intraocular pressure fluctuations (preoperative IOP 15.0 ± 2.43 vs 1year IOP 14.69 ± 2.27 p > 0.3), changes in endothelial cell counts (CC) (Preoperative CC: 1812 ± 461 cell/mm2 vs 1year 1760 ± 329 cell/mm2; p > 0.3), or significant complications were observed. This novel surgical technique may represent a viable, economic, and durable solution to restore dislocations of IOLs accessible from the anterior chamber that respect the cornea and restores visual function without damaging ocular structures.

There are many surgical approaches for treating intraocular lens (IOL) dislocation, subluxation or situations when there is inadequate capsular support. This study evaluated the results of a single surgeon case series using the haptic externalization scleral suture (HESS) technique. This was a retrospective, consecutive series of 223 patients with IOL fixation using the HESS technique. The same HESS technique was used in all patients. Patient demographics, surgical indications, ocular conditions, visual acuity (VA), and intraocular pressure (IOP) were recorded preoperatively. Postoperatively, VA, IOP, and complications were recorded at the 3-month, 1-year, 2-year, and final postoperative visits. The 223 eyes 148 IOL repositioning surgeries, 54 IOL placements in aphakic patients, 12 IOL exchanges, and 9 lensectomies with IOL insertion. Median follow-up time was 3.39 years (91 days-22 years). There was a VA improvement from logMAR 1.14±0.05 (20/250-2) preoperatively to 0.48±0.04 (20/63+1) postoperatively (p<0.0001). The rate of IOL dislocation postoperatively requiring reoperation was 9/223(4%). Insertion of a new IOL was associated with a higher rate of postoperative corneal edema 9/75(12%) compared to IOL repositioning 5/148(3%) (p=0.012). This large retrospective study highlights the success of the HESS technique for correcting IOL subluxation, dislocation, and aphakia and how repositioning of the IOL compared to IOL exchange helps to minimize the risk of corneal edema with robust VA improvement and relatively low reoperation rates.

We introduce a hybrid surgical approach for Carlevale intraocular lens (IOL) fixation, combining scleral and Hoffman pocket techniques to address preoperative conjunctival scarring in a patient with IOL dislocation requiring exchange. The dislocated IOL was removed, and a Carlevale IOL was implanted with a classical scleral fixation nasally and the Hoffman technique temporally due to conjunctival scarring from previous strabismus surgery. During follow-up, the Carlevale IOL remained stable and visual acuity improved significantly. This hybrid approach, integrating Hoffman pocket without conjunctival dissection, is a viable alternative when conjunctival scarring is present, expanding the surgical options for Carlevale IOL fixation.

Dead bag syndrome, a clinical entity involving late-onset intraocular lens (IOL) subluxation with an unusually clear and floppy capsular bag, has gained recognition in ophthalmology, prompting reevaluation of late IOL subluxation management. We present a case of a 53-year-old male with diplopia in the left eye, four years post-uncomplicated cataract surgery and IOL implantation. Examination revealed bilateral IOL subluxation within dilated, transparent capsular bags. The patient underwent IOL suspension in the left eye, and subsequent pathological analysis identified the absence of lens epithelial cells and basement membrane splitting. This report provides comprehensive clinical, surgical, and histopathological insights into bilateral dead bag syndrome, exploring potential mechanisms of its pathogenesis. Further research is essential to clarify the underlying cause and improve management of this rare complication.

Assessment of the Cataract Patients’ Knowledge about Indicators of Intraocular Lenses Dislocation and Malposition

Objective. To evaluate the efficacy of two-stage approach to surgical treatment of secondary pseudophakic glaucoma resulting from intraocular lens (IOL) dislocation on the basis of a clinical example. Material and methods. A woman with complaints of decreased acuity and narrowing of the visual field in the left eye came to S. Fyodorov Eye Microsurgery Federal State Institution (Moscow). In 2014 she underwent cataract surgery in the left eye (OS Phacoemulsification with IOL and intracapsular ring implantation). The patient underwent a complete ophthalmologic examination. Results. At the initial treatment, the patient’s maximal visual acuity corrected on OS amounted to 0.4 D. According to Maklakov tonometry, intraocular pressure (IOP) at OS was 25 mm Hg, on maximal hypotensive therapy. According to perimetry data, there was a narrowing of the OS visual field to 20 degrees on the nasal side. At ultrasound biomicroscopy, a downward shifted IOL was visualized, at 13 o’clock the haptic part was located in the ciliary sulcus, at 7 o’clock in the capsular bag, from 5 to 8 o’clock there was total lysis of Zinn ligament fibers. The patient underwent implantation of the Ahmed antiglaucomatous valve in the first stage, one month later the second stage was repositioning with suturing of the intraocular lens. After two-stage surgical treatment, the patient’s maximal visual acuity corrected at OS was 0.6D. According to Maklakov tonometry, the IOP at OS was 19 mm Hg without hypotensive therapy. According to the perimetry data, no further narrowing of the visual fields on OS, compared to the initial data, was observed. During ultrasound biomicroscopy, an Ahmed valve tube was visualized in the anterior chamber, its lumen was free. The IOL was sutured to the iris at 5 o’clock, to the sclera at 12 o’clock, centered, the optical part in the pupil area. Conclusion. Treatment of secondary pseudophakic glaucoma is difficult, as conservative therapy does not always lead to the desired result. In situations where drug treatment is not effective enough, surgery is the only method of choice. Two-stage approach to surgical treatment of secondary pseudophakic glaucoma caused by IOL dislocation demonstrates high efficiency due to hypotensive effect of Ahmed valve and prevention of contact of dislocated IOL with uveal structures. This strategy helps to restore the balance between intraocular fluid production and outflow, normalize IOP and preserve the patient’s visual functions in the postoperative period. Keywords: two-stage approach; glaucoma; IOL dislocation; visual acuity; IOP

To investigate the clinical characteristics, risk factors, and short-term visual outcomes following surgical management of intraocular lens (IOL) dislocation, aiming to inform risk stratification and individualized treatment strategies. A retrospective analysis was conducted on 155 patients (166 eyes) diagnosed with IOL dislocation between 2016 and 2024. Data collected included demographic information, ocular and systemic risk factors, surgical interventions, uncorrected distance visual acuity (UDVA) before and after surgery, and postoperative complications. Comparative analyses were performed to assess the short-term efficacy and safety of different surgical approaches. The mean patient age was 55 years, with 86.75% presenting unilateral dislocation. Predominant risk factors identified were high myopia (38.55%) and prior vitrectomy (17.47%). A total of 89.16% of IOL dislocations were classified as late-onset. Of the 154 eyes that underwent surgical intervention, both IOL repositioning and exchange procedures resulted in significant improvements in UDVA (P < 0.05). Postoperative transient intraocular pressure elevations were observed without significant differences between surgical methods, resolving within three days in all cases. High myopia and prior vitrectomy are significant risk factors for IOL dislocation. Surgical correction, whether through repositioning or exchange, is effective and safe, leading to substantial visual acuity improvements. Proactive identification and management of high-risk individuals are crucial for preventing IOL dislocation and optimizing patient outcomes.

ObjectiveTo investigate the clinical characteristics, risk factors, and short-term visual outcomes following surgical management of intraocular lens (IOL) dislocation, aiming to inform risk stratification and individualized treatment strategies.MethodsA retrospective analysis was conducted on 155 patients (166 eyes) diagnosed with IOL dislocation between 2016 and 2024. Data collected included demographic information, ocular and systemic risk factors, surgical interventions, uncorrected distance visual acuity (UDVA) before and after surgery, and postoperative complications. Comparative analyses were performed to assess the short-term efficacy and safety of different surgical approaches.ResultsThe mean patient age was 55 years, with 86.75% presenting unilateral dislocation. Predominant risk factors identified were high myopia (38.55%) and prior vitrectomy (17.47%). A total of 89.16% of IOL dislocations were classified as late-onset. Of the 154 eyes that underwent surgical intervention, both IOL repositioning and exchange procedures resulted in significant improvements in UDVA (P < 0.05). Postoperative transient intraocular pressure elevations were observed without significant differences between surgical methods, resolving within three days in all cases.ConclusionHigh myopia and prior vitrectomy are significant risk factors for IOL dislocation. Surgical correction, whether through repositioning or exchange, is effective and safe, leading to substantial visual acuity improvements. Proactive identification and management of high-risk individuals are crucial for preventing IOL dislocation and optimizing patient outcomes.

Background/Objectives: Different surgical techniques are available in cases of missing or insufficient capsular bag support. Next to the anterior chamber or iris-fixated intraocular lenses (IOL), the implantation of the Carlevale IOL provides a sutureless and scleral fixated treatment method. Methods: In a retrospective single-center study, the perioperative data of 100 patients who consecutively received a scleral fixated Carlevale IOL combined with a 25 gauge (G) pars plana vitrectomy between September 2021 and June 2024 were investigated. The intraoperative and postoperative results were analyzed in terms of complication rates and refractive outcomes. Results: IOL dislocation was the most common surgical indication (50%) for sutureless Carlevale IOL implantation, followed by postoperative aphakia in 35 patients (35%). Nearly every fourth patient (24%) had a preoperative traumatic event, and 21% had pseudoexfoliation (PEX) syndrome. The average surgery time was 60.2 (±20.1) min. Intraoperative intraocular hemorrhage occurred in seven cases, and IOL haptic breakage in two patients. Temporary intraocular pressure fluctuations represented the most common postoperative complications (28%). Severe complications such as endophthalmitis or retinal detachment were not observed in our cohort. The mean refractive prediction error was determined in 67 patients and amounted to an average of −0.7 ± 2.0 diopters. The best corrected visual acuity (BCVA) at the last postoperative follow-up showed an improvement of 0.2 ± 0.5 logMAR (n = 76) compared to the preoperative BCVA (p = 0.0002). The postoperative examination was performed in 72% of the patients, and the mean follow-up period amounted to 7.2 ± 6.4 months. Conclusions: Overall, sutureless and scleral fixated implantation of the Carlevale IOL represents a valuable therapeutic option in the treatment of aphakia and lens as well as IOL dislocation in the absence of capsular bag support with minor postoperative complications and positive refractive outcomes.

Purpose: Intraocular lens (IOL) dislocation is a relatively common complication after cataract surgery, leading to an increase in intraocular pressure (IOP) following IOL dislocation surgery. This study investigated the long-term clinical course of patients who experienced IOP elevation after IOL dislocation surgery.Methods: This retrospective study analyzed 65 patients who underwent IOL dislocation surgery by a single retinal specialist from January 2020 to December 2022. The patients were divided into high (≥ 22 mmHg) and normal (&lt; 22 mmHg) IOP groups based on the IOP within 1 week of surgery. IOP was tracked for over a year to assess the incidence of glaucoma.Results: There were no significant (&lt;i&gt;p&lt;/i&gt; = 0.254) differences in dislocation types between the high (48 patients) and normal (17 patients) IOP groups. One month after surgery, the mean IOP was 18.6 ± 5.9 mmHg in the high IOP group and 14.3 ± 4.0 mmHg in the normal IOP group (&lt;i&gt;p&lt;/i&gt; &lt; 0.001). At 1 year, the values were 15.3 ± 3.7 and 16.2 ± 5.0 mmHg, respectively (&lt;i&gt;p&lt;/i&gt; = 0.696). One week after surgery, the high IOP group used 1.2 ± 0.8 IOP-lowering medications compared to 0.2 ± 0.7 in the normal IOP group (&lt;i&gt;p&lt;/i&gt; &lt; 0.001). At the final follow-up, medication use was 0.5 ± 0.9 and 0.2 ± 0.6, respectively (&lt;i&gt;p&lt;/i&gt; = 0.227).Conclusions: Although IOP elevation may occur following IOL dislocation surgery, it tends to improve over time.

To assess trends in prevalence and patient/surgeon characteristics of intraocular lens (IOL) exchange surgery in the United States and to evaluate the surgical complication rates. Medicare beneficiaries. Retrospective cross-sectional analysis. Medicare beneficiaries aged 65 years or older who underwent IOL exchange surgery between 2011 and 2020 were identified from 100% Medicare fee-for-service carrier claims data. Main exclusion criteria: missing demographic information and incomplete follow-up data. Main outcomes: incidence of IOL exchange, patient-level and surgeon-level factors, and postoperative complication rates. 52 583 IOL exchanges were performed on 48 967 patients. The annual number of IOL exchanges increased from 4621 in 2011 to 6114 in 2019. Most patients were White (n = 47 228, 89.8%), resided in urban locations (n = 44 095, 84.0%), and had a Charlson comorbidity index of ≤2 (n = 41 556, 79.0%). Of 7493 surgeons, most were male (n = 6308, 84.2%), practiced in urban locations (n = 6907, 92.2%), and had an average of 24.7 ± 11.2 years between medical school graduation and the last surgery they performed during the study period. The most common surgical indications were mechanical lens failure (n = 22 252, 51.4%) and lens displacement (n = 9155, 21.1%). The most common complications were epiretinal membrane (ERM) (n = 531, 6.8%), mechanical lens complication (n = 460, 5.9%), and dislocation of the replacement IOL (n = 385, 4.9%). The number of IOL exchange procedures performed among Medicare beneficiaries increased over the past decade. Male ophthalmologists in urban locations performed the majority of IOL exchanges. The most common postoperative complication was ERM. The rates of corneal decompensation, retinal detachment, and endophthalmitis were low.

Objective. To demonstrate a method of transscleral suture fixation of a hydrophobic posterior chamber S-shaped intraocular lens (IOL) using a clinical case as an example. Method. Patient A., 75 years old, was admitted with complaints of low visual acuity in the left eye, episodic redness of the left eye. According to the patient, in 2010, phacoemulsification with implantation of an OU IOL was performed at his place of residence. In 2015, OU glaucoma was diagnosed by m/f, instillation of OU Sol.Timololi 0.5% 1 drop 2 times a day in both eyes. According to the examination data: visual acuity of the left eye (Visus) 0.05 sph +7.0 = 0.5, intraocular pressure (IOP) (pneumotonometry) 23 mm Hg. On biomicroscopy of the left eye: the cornea is transparent, the depth of the anterior chamber is wide, the iris is subatrophic, the pupil is round, 5 mm (medicinal mydriasis), pseudoexfoliation along the edge, iridodonesis, the vitreous cavity is destruction of the vitreous body, the IOL is visualized in the lower segment, not fixed to the membranes, the fundus: the optic disc is pale, the borders are clear, the ratio of the excavation to the disc is 0.7. M3 - without special features. According to the results of ultrasound ophthalmoscanning in B-mode, the IOL was determined in the posterior pole with the patient lying down, moving to the lower segment in the sitting position. According to the results of computer perimetry, concentric narrowing of the visual fields was determined. The diagnosis was: OS Aphakia. Dislocation of the IOL into the vitreous cavity. Primary open-angle glucocorticoid 2a. Pseudoexfoliation syndrome. As a result, a decision was made to perform surgical treatment - IOL removal and IOL implantation with suturing to the sclera. During the intervention, three 27G ports were installed at 2, 8 and 10 o'clock and 2 paracenteses were formed at 3, 9 o'clock and the main incision at 11 o'clock, 2.5 mm long. A dislocated IOL is visualized in the fundus, freely lying in the vitreous cavity, mobile. Central and peripheral vitrectomy was performed. Then, using straight endovitreal tweezers, the IOL was brought out to the pupil area and dislocated into the anterior chamber, previously filled with adhesive viscoelastic. Using scissors, the IOL was divided into 2 halves and removed through the main incision. Next, the IOL was ab externo sutured with non-absorbable 6/0 polypropylene suture material, and the remaining free posterior ends of the threads were coagulated using a thermal cautery to form a posterior fixing flange. Then the sutured IOL was implanted together with the remaining part of the 6-0 polypropylene thread after cutting off the needle into the posterior chamber through a standard cartridge. Then, using a 32 G curved injection needle, a primary scleral puncture was made 1.5 mm from the limbus into the posterior chamber of the eye at 60°, then one of the free anterior ends of the 6-0 polypropylene thread was inserted into the lumen of the guide needle using 25 G straight endovitreal tweezers and brought out of the eye, then the second free anterior end of the 6-0 polypropylene thread was brought out in the same way from the opposite side at 240°, then using two IOL tying tweezers, they were centered and fixing flanges were formed on the anterior free ends of the threads using a thermal cautery. Then, a revision of the vitreous cavity was performed. Sealing of corneal and scleral incisions without sutures. Results. The surgical intervention was performed without complications. In the postoperative period, standard anti-inflammatory and antibacterial therapy were prescribed. On the first day after the surgery: visual acuity of the left eye is 0.6 n/c, IOP of the left eye (pneumotonometry) is 15 mm Hg. The IOL was in a stable central position. According to the ultrasound ophthalmoscanning data in B-mode: the shells are adjacent. One month after the intervention: visual acuity of the left eye is 0.7 without correction, IOP is 17 mm Hg. Conclusions. The specified method of surgical treatment allows achieving a stable and centered position of the IOL and can be used to correct corneal astigmatism of a toric IOL in aphakia. Key words: polypropylene 6/0, transscleral fixation of the IOL, IOL dislocation

To report the indications and outcomes of intraocular lens (IOL) exchange at a tertiary referral center in northern China over a period of 8 years. Setting: Ophthalmology departments of Hebei Eye Hospital, Hebei, China. Design: Retrospective cross-sectional study. In this retrospective study, the medical records of 233 patients with a history of IOL exchange were reviewed between 2016 and 2024. These cases were reviewed to determine surgical indications, the type of intraocular lens removed, the type of intraocular lens implanted, the time between operations, surgical complications, and visual outcomes. All postoperative data were analyzed at least six months after follow-up. The mean age of our participants was 50.05 ± 21.76 years (range 5–82 years), with a male percentage of 65.67%. The mean time between primary surgery and IOL exchange was 6.64 ± 6.16years (range 0.01–30 year). The main indications of IOL exchange were IOL dislocation (63.37%) and IOL opacification (21.81%). The most common ophthalmic comorbidity was high myopia. Procedures for secondary IOL implantation were scleral fixated IOL with sutures (34.16%), IOL in ciliary sulcus (26.75%), in-the-bag IOL (26.31%) and Iris fixation IOL (7.82%). The mean postoperative corrected distance visual acuity (CDVA) was significantly higher compared to the mean preoperative CDVA (p = 0.00). The mean preoperative and postoperative IOP were 16.23 ± 4.92 and 14.84 ± 3.05 mmHg, respectively (p = 0.00). No serious complications ware observed. IOL dislocation is the most common indication of intraocular lens implantation, followed by IOL opacification. Simultaneous scleral-sutured fixation after IOL replacement is the most common procedure in secondary IOL implantation.