This is a case of posterior Dislocation of Intra ocular lens, with inadequate posterior capsular support . The retina was attached but there was fibrous tissue proliferation and picture of old Branch Retinal Vein occlusion. Priorities: either to retrieve the IOL to the anterior chamber level and keep till end of surgery then exchange. OR Explantation of the IOL at the beginning of the procedure then complete the vitrectomy, then implant. OR to keep the IOL in the posterior segment, manage the vitreoretinal pathology then exchange the IOL at the end. Obstacles in this case were: the IOL is a single piece foldable acrylic IOL: cannot be maintained in the anterior chamber level although the procedure…. re dislocation is inevitable. Epiretinal fibrous tissue entail a cautious management the posterior Hyaloid needs to be meticulously managed….. interference of the IOL during suction is a difficulty. early Explantation of the IOL will disturb the intra ocular fluid dynamics. I selected the 3rd option. i used a Bimanual Approach; holding the IOL with forceps by one hand. the other hand was used to hold a Tano scraper then vitreous cutter probe for management of the posterior hyaloid. Then i performed a fluid/air exchange, explanted the IOL, and finally i implanted a posterior Iris Claw lens under Air.

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