1. 90 y o, 20 y after cataract surgery, 3 y after suturing of left eye, 20/400 preop, 20/40 post op, removal retained lens material

2. Why reposition and suture instead of replace • Replacement with large one piece PMMA sclerally sutured IOL • Requires large incision • Long healing time and visual recovery • In older patients may be very significant time • Replacement with AC IOL • Longer healing time

4. dislocation after complicated cataract surgery in patient with NAG s/p PI OU, 20/200 preop, 20/50 post op fixation, secondary BK, 20/40 after DSEK

5. B, 70 y o Dsek 2007, lens sutured 2 years later, +cme

6. reasener

11. Oval pupil corrected with iridoplasty

12. After lens suturing and iridoplasty

13. Siepser knot

15. Why iridoplasty? • Better optics and less glare • Less peripheral anterior Synecheia • Less decrease in outflow • Better tolerance of mild lens decentration

16. Complications of repair • Retinal detachment • Glaucoma • Corneal edema • Cystoid macular edema • Recurrence of dislocations

18. Dislocated IOLs • A problem? YES • When to treat: • Prevention: larger capsulotomies, • Capsular tension rings? • When lens causing symptoms or likely to sublux • Surgical options • With appropriate repair outcomes are excellent and recurrences are rare • The least invasive procedure is the best, iris suturing leads to consistent excellent results