- Pars plana lensectomy by retinal surgeon and insertion of AC IOL
- Intracapsular cataract exctraction and insertion of AC IOL
- Phacoemulsification and insertion of a capsular tension ring (CTR) and PC IOL
- Phacoemulsification and iris sutured PC IOL
Correct Answer: Pars plana lensectomy by retinal surgeon and insertion of AC IOL
This patient has a subluxed cataract with greater than 180 degrees of zonular dehiscence. Although a CTR can be placed and even sewn into the sulcus to refixate the capsule and allow an IOL to be placed in the bag, phacoemulsification in this situation has a significant risk of dropping nucleus and losing vitreous, furthermore, depending on the underlying cause of the ectopia lentis, future zonular loss may occur with dislocation of the IOL-bag complex. ICCE is quite traumatic requiring a very large wound and associated with a high incidence of vitreous loss. The safest method of cataract removal in this situation is a pars plana approach by a retinal surgeon.