We describe a unique case of IOL luxation through a small fragile zonule zone without compromising capsular stability. Our surgical technique allowed the explantation of the luxated posterior-chamber phakic IOL throught a limbal incision, maintaining a good capsular support for the secondary implantation of a new IOL.


A 31-years-old man was referred to our emergency department with a subluxated Phakic Refractive Lens (PRL), a phakic posterior-chamber IOL. The explantation of the IOL and implantation of an anterior-chamber IOL fixated to the iris were planned, however, due to agenda issues, the IOL completely luxated to the vitreous cavity before this surgical approach was achieved. Therefore, the patient underwent a lens aspiration and a pars plana vitrectomy to attempt the IOL explantation, via a limbal incision. The video illustrates the intraoperative difficulties in managing an ultra-thin, elastic and hydrophobic IOL during its explantation from the vitreous cavity. After a posterior capsulotomy was performed, the IOL was removed through the anterior chamber, via a limbal incision, and a new IOL was placed in the capsular bag. However, an unexpected malposition in the sulcus lead to re-subluxation of the new IOL through the same fragile zonule zone. A second surgical time was necessary, in wh ich a capsular tension ring was introduced and the reposition of the IOL to the capsular bag was performed. After 3 months of follow-up, we achieved an optimal visual acuity and the lens remained centered and stable.

Effectiveness / Safety:

This is the first description of the removal of a posterior-chamber phakic IOL from the vitreous cavity. The IOL could be safely explanted through the posterior capsulotomy and limbal incision, providing a stable capsular bag to the secondary implantation of a new IOL. With the described technique, we achieved an excellent anatomical and functional result.


Filipe HENRIQUES, Joana PROVIDENCIA, Andreia Silva
Centro Hospitalar e Universitário de Coimbra
Coimbra, Portugal
Email: filh1967@gmail.com
Cell Phone: +351918362497
Work Phone: +351918362497