Subluxed IOL removal

While observing at a local surgery center today, I watched the removal of a subluxated IOL today. The patient was in her 80s and had cataract surgery performed several years ago; over time, the IOL (and capsule) had been displaced dramatically - it looked exactly like the classic Marfan's photos. Apparently it is not uncommon for older cataract surgeries to result in zonule weakening down the road and IOL displacement. This lady had also undergone several YAG surgeries for PCOs, so the posterior capsule had large holes in it.

The surgeon was visibly nervous and had a real struggle to get the lens out - the patient's pupils were poorly dilated, and every time he tried to grab the IOL and move it anterior to the iris, the haptics would snap back and damage the iris. After practically destroying the woman's iris (I could clearly see retina through one segment), he finally resorted to cutting the IOL in half with scissors, then cutting the haptics off, and removing it piece by piece. By that time, he had made more than one large corneal incision of >4 mm. I estimated that over 1/3 of the corneal circumference had been cut open on one end, with smaller incisions on the other side as well - can you say "specialty contact lens fit?" That woman is bound to have gobs of post-op astigmatism.

After removing the IOL, the surgeon pulled some iris tissue through one of the incisions, snipped it to create a nice PI, then inserted an anterior chamber IOL.