Purpose: This study evaluated the long-term outcomes of managing posterior chamber intra-ocular lens (IOL) (PCIOL) subluxation through pars plana vitrectomy (PPV) with IOL iris suturing.Retrospective chart review.Patients who underwent PPV with iris-sutured IOL (IS-IOL) for IOL subluxation between January 2008 and April 2021 at a tertiary center with a minimum of 6 months of follow-up were included. The patients were divided into two groups: those who had prior PPV and those who had not undergone the procedure.A total of 54 patients underwent iris suturing of a subluxated IOL. Among them, 36 (66%) had previously undergone PPV, while 18 patients (33%) had not. The etiology of PCIOL subluxation was uncertain in 20 (37.0%), prior PPV in 17 (32%), and following complicated cataract surgery in 11 (20%) cases. The mean time between original IOL insertion and IS-IOL was 6.1 +/- 7.0 years. The mean follow-up duration was 46.8 +/- 39.7 months. The mean post-operative best corrected visual acuity (BCVA) was logMAR 0.43 +/- 0.52 at final follow-up, a significant improvement from pre-operative BCVA. Vision was significantly better in the group with no prior PPV (logMAR 0.54 +/- 0.59 vs. 0.21 +/- 0.23 at final follow-up, P = 0.026). At final follow-up, 34 (63%) eyes had BCVA of 20/40 or better. The most common complication was cystoid macular edema, attributed to the IS-IOL in 13 (21.4%) eyes, 11 (68.6%) of which resolved or improved.The management of posterior chamber IOL subluxations with PPV and iris suturing of the subluxated IOL is a safe technique that provides excellent long-term visual outcomes.Posterior chamber intra-ocular lens (PCIOL) subluxation is a rare complication following standard phacoemulsification and PCIOL implantation. The reported cumulative risk of post-operative IOL subluxation is 0.1% at 5 and 10 years and 0.2% at 15 years, 0.7% at 20 years, and 1.7% at 20 years.[1] Other studies have reported subluxation rates between 0.3% and 2%.[2-9] PCIOL subluxation can be classified as early if it occurs within 3 months of the initial cataract surgery and late if it occurs any time after 3 months.[2] Early PCIOL subluxation is typically attributed to lens instability within the capsular bag or ruptured zonules, while late subluxation is associated with progressive zonular insufficiency and contraction of the capsular bag.[2] In these cases, the IOL subluxation occurs with the lens still within the capsular bag. Several known risk factors for late-onset PCIOL subluxation include prior pars plana vitrectomy (PPV) or complicated cataract surgery, trauma, myopia, and other causes of zonular insufficiency, such as pseudoexfoliation syndrome.[2,6]There are several potential options for management of PCIOL subluxation, including PPV with PCIOL exchange and placement of a scleral-sutured or transconjunctival scleral-fixated IOL, placement of an anterior chamber IOL (ACIOL), or placement of an iris claw IOL.[3,6,10] However, these methods involve IOL exchange, a time-consuming and costly procedure known to carry risks for the corneal endothelium.[3,6,11,12] An alternative approach that eliminates the need for IOL exchange is PPV with direct suturing of the subluxed PCIOL to the iris.[6,13] This technique has broader applications beyond PCIOL subluxation, including cases of aphakia and ectopia lentis.[3] While scleral-fixated IOLs are more commonly used, iris-sutured IOLs can be an interesting alternative in specific situations. The objective of this study is to assess the long-term outcomes of managing PCIOL subluxations with PPV and suturing of the subluxed PCIOL to the iris. This study evaluates the etiologies of PCIOL subluxation, visual outcomes, and complication rates in patients who underwent this technique. Additionally, we sought to establish potential differences within the sub-cohort of patients having undergone previous PPV. To the best of our knowledge, this study presents the largest case series to date on the management of dislocated lenses using iris suturing.Purpose: This study evaluated the long-term outcomes of managing posterior chamber intra-ocular lens (IOL) (PCIOL) subluxation through pars plana vitrectomy (PPV) with IOL iris suturing.Retrospective chart review.Patients who underwent PPV with iris-sutured IOL (IS-IOL) for IOL subluxation between January 2008 and April 2021 at a tertiary center with a minimum of 6 months of follow-up were included. The patients were divided into two groups: those who had prior PPV and those who had not undergone the procedure.A total of 54 patients underwent iris suturing of a subluxated IOL. Among them, 36 (66%) had previously undergone PPV, while 18 patients (33%) had not. The etiology of PCIOL subluxation was uncertain in 20 (37.0%), prior PPV in 17 (32%), and following complicated cataract surgery in 11 (20%) cases. The mean time between original IOL insertion and IS-IOL was 6.1 +/- 7.0 years. The mean follow-up duration was 46.8 +/- 39.7 months. The mean post-operative best corrected visual acuity (BCVA) was logMAR 0.43 +/- 0.52 at final follow-up, a significant improvement from pre-operative BCVA. Vision was significantly better in the group with no prior PPV (logMAR 0.54 +/- 0.59 vs. 0.21 +/- 0.23 at final follow-up, P = 0.026). At final follow-up, 34 (63%) eyes had BCVA of 20/40 or better. The most common complication was cystoid macular edema, attributed to the IS-IOL in 13 (21.4%) eyes, 11 (68.6%) of which resolved or improved.The management of posterior chamber IOL subluxations with PPV and iris suturing of the subluxated IOL is a safe technique that provides excellent long-term visual outcomes.Posterior chamber intra-ocular lens (PCIOL) subluxation is a rare complication following standard phacoemulsification and PCIOL implantation. The reported cumulative risk of post-operative IOL subluxation is 0.1% at 5 and 10 years and 0.2% at 15 years, 0.7% at 20 years, and 1.7% at 20 years.[1] Other studies have reported subluxation rates between 0.3% and 2%.[2-9] PCIOL subluxation can be classified as early if it occurs within 3 months of the initial cataract surgery and late if it occurs any time after 3 months.[2] Early PCIOL subluxation is typically attributed to lens instability within the capsular bag or ruptured zonules, while late subluxation is associated with progressive zonular insufficiency and contraction of the capsular bag.[2] In these cases, the IOL subluxation occurs with the lens still within the capsular bag. Several known risk factors for late-onset PCIOL subluxation include prior pars plana vitrectomy (PPV) or complicated cataract surgery, trauma, myopia, and other causes of zonular insufficiency, such as pseudoexfoliation syndrome.[2,6]There are several potential options for management of PCIOL subluxation, including PPV with PCIOL exchange and placement of a scleral-sutured or transconjunctival scleral-fixated IOL, placement of an anterior chamber IOL (ACIOL), or placement of an iris claw IOL. [3,6,10] However, these methods involve IOL exchange, a time-consuming and costly procedure known to carry risks for the corneal endothelium.[3,6,11,12] An alternative approach that eliminates the need for IOL exchange is PPV with direct suturing of the subluxed PCIOL to the iris.[6,13] This technique has broader applications beyond PCIOL subluxation, including cases of aphakia and ectopia lentis.[3] While scleral-fixated IOLs are more commonly used, iris-sutured IOLs can be an interesting alternative in specific situations.The objective of this study is to assess the long-term outcomes of managing PCIOL subluxations with PPV and suturing of the subluxed PCIOL to the iris. This study evaluates the etiologies of PCIOL subluxation, visual outcomes, and complication rates in patients who underwent this technique. Additionally, we sought to establish potential differences within the sub-cohort of patients having undergone previous PPV. To the best of our knowledge, this study presents the largest case series to date on the management of dislocated lenses using iris suturing.Purpose: This study evaluated the long-term outcomes of managing posterior chamber intra-ocular lens (IOL) (PCIOL) subluxation through pars plana vitrectomy (PPV) with IOL iris suturing.Retrospective chart review.Patients who underwent PPV with iris-sutured IOL (IS-IOL) for IOL subluxation between January 2008 and April 2021 at a tertiary center with a minimum of 6 months of follow-up were included. The patients were divided into two groups: those who had prior PPV and those who had not undergone the procedure.A total of 54 patients underwent iris suturing of a subluxated IOL. Among them, 36 (66%) had previously undergone PPV, while 18 patients (33%) had not. The etiology of PCIOL subluxation was uncertain in 20 (37.0%), prior PPV in 17 (32%), and following complicated cataract surgery in 11 (20%) cases. The mean time between original IOL insertion and IS-IOL was 6.1 +/- 7.0 years. The mean follow-up duration was 46.8 +/- 39.7 months. The mean post-operative best corrected visual acuity (BCVA) was logMAR 0.43 +/- 0.52 at final follow-up, a significant improvement from pre-operative BCVA. Vision was significantly better in the group with no prior PPV (logMAR 0.54 +/- 0.59 vs. 0.21 +/- 0.23 at final follow-up, P = 0.026). At final follow-up, 34 (63%) eyes had BCVA of 20/40 or better. The most common complication was cystoid macular edema, attributed to the IS-IOL in 13 (21.4%) eyes, 11 (68.6%) of which resolved or improved.The management of posterior chamber IOL subluxations with PPV and iris suturing of the subluxated IOL is a safe technique that provides excellent long-term visual outcomes.Posterior chamber intra-ocular lens (PCIOL) subluxation is a rare complication following standard phacoemulsification and PCIOL implantation. The reported cumulative risk of post-operative IOL subluxation is 0.1% at 5 and 10 years and 0.2% at 15 years, 0.7% at 20 years, and 1.7% at 20 years.[1] Other studies have reported subluxation rates between 0.3% and 2%.[2-9] PCIOL subluxation can be classified as early if it occurs within 3 months of the initial cataract surgery and late if it occurs any time after 3 months.[2] Early PCIOL subluxation is typically attributed to lens instability within the capsular bag or ruptured zonules, while late subluxation is associated with progressive zonular insufficiency and contraction of the capsular bag.[2] In these cases, the IOL subluxation occurs with the lens still within the capsular bag. Several known risk factors for late-onset PCIOL subluxation include prior pars plana vitrectomy (PPV) or complicated cataract surgery, trauma, myopia, and other causes of zonular insufficiency, such as pseudoexfoliation syndrome.[2,6]There are several potential options for management of PCIOL subluxation, including PPV with PCIOL exchange and placement of a scleral-sutured or transconjunctival scleral-fixated IOL, placement of an anterior chamber IOL (ACIOL), or placement of an iris claw IOL.[3,6,10] However, these methods involve IOL exchange, a time-consuming and costly procedure known to carry risks for the corneal endothelium.[3,6,11,12] An alternative approach that eliminates the need for IOL exchange is PPV with direct suturing of the subluxed PCIOL to the iris.[6,13] This technique has broader applications beyond PCIOL subluxation, including cases of aphakia and ectopia lentis.[3] While scleral-fixated IOLs are more commonly used, iris-sutured IOLs can be an interesting alternative in specific situations.The objective of this study is to assess the long-term outcomes of managing PCIOL subluxations with PPV and suturing of the subluxed PCIOL to the iris. This study evaluates the etiologies of PCIOL subluxation, visual outcomes, and complication rates in patients who underwent this technique. Additionally, we sought to establish potential differences within the sub-cohort of patients having undergone previous PPV. To the best of our knowledge, this study presents the largest case series to date on the management of dislocated lenses using iris suturing.Purpose: This study evaluated the long-term outcomes of managing posterior chamber intra-ocular lens (IOL) (PCIOL) subluxation through pars plana vitrectomy (PPV) with IOL iris suturing.Retrospective chart review.Patients who underwent PPV with iris-sutured IOL (IS-IOL) for IOL subluxation between January 2008 and April 2021 at a tertiary center with a minimum of 6 months of follow-up were included. The patients were divided into two groups: those who had prior PPV and those who had not undergone the procedure.A total of 54 patients underwent iris suturing of a subluxated IOL. Among them, 36 (66%) had previously undergone PPV, while 18 patients (33%) had not. The etiology of PCIOL subluxation was uncertain in 20 (37.0%), prior PPV in 17 (32%), and following complicated cataract surgery in 11 (20%) cases. The mean time between original IOL insertion and IS-IOL was 6.1 +/- 7.0 years. The mean follow-up duration was 46.8 +/- 39.7 months. The mean post-operative best corrected visual acuity (BCVA) was logMAR 0.43 +/- 0.52 at final follow-up, a significant improvement from pre-operative BCVA. Vision was significantly better in the group with no prior PPV (logMAR 0.54 +/- 0.59 vs. 0.21 +/- 0.23 at final follow-up, P = 0.026). At final follow-up, 34 (63%) eyes had BCVA of 20/40 or better. The most common complication was cystoid macular edema, attributed to the IS-IOL in 13 (21.4%) eyes, 11 (68.6%) of which resolved or improved.The management of posterior chamber IOL subluxations with PPV and iris suturing of the subluxated IOL is a safe technique that provides excellent long-term visual outcomes.Posterior chamber intra-ocular lens (PCIOL) subluxation is a rare complication following standard phacoemulsification and PCIOL implantation. The reported cumulative risk of post-operative IOL subluxation is 0.1% at 5 and 10 years and 0.2% at 15 years, 0.7% at 20 years, and 1.7% at 20 years.[1] Other studies have reported subluxation rates between 0.3% and 2%. [2-9] PCIOL subluxation can be classified as early if it occurs within 3 months of the initial cataract surgery and late if it occurs any time after 3 months.[2] Early PCIOL subluxation is typically attributed to lens instability within the capsular bag or ruptured zonules, while late subluxation is associated with progressive zonular insufficiency and contraction of the capsular bag.[2] In these cases, the IOL subluxation occurs with the lens still within the capsular bag. Several known risk factors for late-onset PCIOL subluxation include prior pars plana vitrectomy (PPV) or complicated cataract surgery, trauma, myopia, and other causes of zonular insufficiency, such as pseudoexfoliation syndrome.[2,6]There are several potential options for management of PCIOL subluxation, including PPV with PCIOL exchange and placement of a scleral-sutured or transconjunctival scleral-fixated IOL, placement of an anterior chamber IOL (ACIOL), or placement of an iris claw IOL.[3,6,10] However, these methods involve IOL exchange, a time-consuming and costly procedure known to carry risks for the corneal endothelium.[3,6,11,12] An alternative approach that eliminates the need for IOL exchange is PPV with direct suturing of the subluxed PCIOL to the iris.[6,13] This technique has broader applications beyond PCIOL subluxation, including cases of aphakia and ectopia lentis.[3] While scleral-fixated IOLs are more commonly used, iris-sutured IOLs can be an interesting alternative in specific situations.The objective of this study is to assess the long-term outcomes of managing PCIOL subluxations with PPV and suturing of the subluxed PCIOL to the iris. This study evaluates the etiologies of PCIOL subluxation, visual outcomes, and complication rates in patients who underwent this technique. Additionally, we sought to establish potential differences within the sub-cohort of patients having undergone previous PPV. To the best of our knowledge, this study presents the largest case series to date on the management of dislocated lenses using iris suturing.Purpose: This study evaluated the long-term outcomes of managing posterior chamber intra-ocular lens (IOL) (PCIOL) subluxation through pars plana vitrectomy (PPV) with IOL iris suturing.Retrospective chart review.Patients who underwent PPV with iris-sutured IOL (IS-IOL) for IOL subluxation between January 2008 and April 2021 at a tertiary center with a minimum of 6 months of follow-up were included. The patients were divided into two groups: those who had prior PPV and those who had not undergone the procedure.A total of 54 patients underwent iris suturing of a subluxated IOL. Among them, 36 (66%) had previously undergone PPV, while 18 patients (33%) had not. The etiology of PCIOL subluxation was uncertain in 20 (37.0%), prior PPV in 17 (32%), and following complicated cataract surgery in 11 (20%) cases. The mean time between original IOL insertion and IS-IOL was 6.1 +/- 7.0 years. The mean follow-up duration was 46.8 +/- 39.7 months. The mean post-operative best corrected visual acuity (BCVA) was logMAR 0.43 +/- 0.52 at final follow-up, a significant improvement from pre-operative BCVA. Vision was significantly better in the group with no prior PPV (logMAR 0.54 +/- 0.59 vs. 0.21 +/- 0.23 at final follow-up, P = 0.026). At final follow-up, 34 (63%) eyes had BCVA of 20/40 or better. The most common complication was cystoid macular edema, attributed to the IS-IOL in 13 (21.4%) eyes, 11 (68.6%) of which resolved or improved. The management of posterior chamber IOL subluxations with PPV and iris suturing of the subluxated IOL is a safe technique that provides excellent long-term visual outcomes.Posterior chamber intra-ocular lens (PCIOL) subluxation is a rare complication following standard phacoemulsification and PCIOL implantation. The reported cumulative risk of post-operative IOL subluxation is 0.1% at 5 and 10 years and 0.2% at 15 years, 0.7% at 20 years, and 1.7% at 20 years.[1] Other studies have reported subluxation rates between 0.3% and 2%.[2-9] PCIOL subluxation can be classified as early if it occurs within 3 months of the initial cataract surgery and late if it occurs any time after 3 months.[2] Early PCIOL subluxation is typically attributed to lens instability within the capsular bag or ruptured zonules, while late subluxation is associated with progressive zonular insufficiency and contraction of the capsular bag.[2] In these cases, the IOL subluxation occurs with the lens still within the capsular bag. Several known risk factors for late-onset PCIOL subluxation include prior pars plana vitrectomy (PPV) or complicated cataract surgery, trauma, myopia, and other causes of zonular insufficiency, such as pseudoexfoliation syndrome.[2,6]There are several potential options for management of PCIOL subluxation, including PPV with PCIOL exchange and placement of a scleral-sutured or transconjunctival scleral-fixated IOL, placement of an anterior chamber IOL (ACIOL), or placement of an iris claw IOL.[3,6,10] However, these methods involve IOL exchange, a time-consuming and costly procedure known to carry risks for the corneal endothelium.[3,6,11,12] An alternative approach that eliminates the need for IOL exchange is PPV with direct suturing of the subluxed PCIOL to the iris.[6,13] This technique has broader applications beyond PCIOL subluxation, including cases of aphakia and ectopia lentis.[3] While scleral-fixated IOLs are more commonly used, iris-sutured IOLs can be an interesting alternative in specific situations.The objective of this study is to assess the long-term outcomes of managing PCIOL subluxations with PPV and suturing of the subluxed PCIOL to the iris. This study evaluates the etiologies of PCIOL subluxation, visual outcomes, and complication rates in patients who underwent this technique. Additionally, we sought to establish potential differences within the sub-cohort of patients having undergone previous PPV. To the best of our knowledge, this study presents the largest case series to date on the management of dislocated lenses using iris suturing.Purpose: This study evaluated the long-term outcomes of managing posterior chamber intra-ocular lens (IOL) (PCIOL) subluxation through pars plana vitrectomy (PPV) with IOL iris suturing.Retrospective chart review.Patients who underwent PPV with iris-sutured IOL (IS-IOL) for IOL subluxation between January 2008 and April 2021 at a tertiary center with a minimum of 6 months of follow-up were included. The patients were divided into two groups: those who had prior PPV and those who had not undergone the procedure.A total of 54 patients underwent iris suturing of a subluxated IOL. Among them, 36 (66%) had previously undergone PPV, while 18 patients (33%) had not. The etiology of PCIOL subluxation was uncertain in 20 (37.0%), prior PPV in 17 (32%), and following complicated cataract surgery in 11 (20%) cases. The mean time between original IOL insertion and IS-IOL was 6.1 +/- 7.0 years. The mean follow-up duration was 46.8 +/- 39.7 months. The mean post-operative best corrected visual acuity (BCVA) was logMAR 0.43 +/- 0.52 at final follow-up, a significant improvement from pre-operative BCVA. Vision was significantly better in the group with no prior PPV (logMAR 0.54 +/- 0.59 vs. 0.21 +/- 0.23 at final follow-up, P = 0.026). At final follow-up, 34 (63%) eyes had BCVA of 20/40 or better. The most common complication was cystoid macular edema, attributed to the IS-IOL in 13 (21.4%) eyes, 11 (68.6%) of which resolved or improved.The management of posterior chamber IOL subluxations with PPV and iris suturing of the subluxated IOL is a safe technique that provides excellent long-term visual outcomes.Posterior chamber intra-ocular lens (PCIOL) subluxation is a rare complication following standard phacoemulsification and PCIOL implantation. The reported cumulative risk of post-operative IOL subluxation is 0.1% at 5 and 10 years and 0.2% at 15 years, 0.7% at 20 years, and 1.7% at 20 years.[1] Other studies have reported subluxation rates between 0.3% and 2%.[2-9] PCIOL subluxation can be classified as early if it occurs within 3 months of the initial cataract surgery and late if it occurs any time after 3 months.[2] Early PCIOL subluxation is typically attributed to lens instability within the capsular bag or ruptured zonules, while late subluxation is associated with progressive zonular insufficiency and contraction of the capsular bag.[2] In these cases, the IOL subluxation occurs with the lens still within the capsular bag. Several known risk factors for late-onset PCIOL subluxation include prior pars plana vitrectomy (PPV) or complicated cataract surgery, trauma, myopia, and other causes of zonular insufficiency, such as pseudoexfoliation syndrome.[2,6]There are several potential options for management of PCIOL subluxation, including PPV with PCIOL exchange and placement of a scleral-sutured or transconjunctival scleral-fixated IOL, placement of an anterior chamber IOL (ACIOL), or placement of an iris claw IOL.[3,6,10] However, these methods involve IOL exchange, a time-consuming and costly procedure known to carry risks for the corneal endothelium.[3,6,11,12] An alternative approach that eliminates the need for IOL exchange is PPV with direct suturing of the subluxed PCIOL to the iris.[6,13] This technique has broader applications beyond PCIOL subluxation, including cases of aphakia and ectopia lentis.[3] While scleral-fixated IOLs are more commonly used, iris-sutured IOLs can be an interesting alternative in specific situations.The objective of this study is to assess the long-term outcomes of managing PCIOL subluxations with PPV and suturing of the subluxed PCIOL to the iris. This study evaluates the etiologies of PCIOL subluxation, visual outcomes, and complication rates in patients who underwent this technique. Additionally, we sought to establish potential differences within the sub-cohort of patients having undergone previous PPV. To the best of our knowledge, this study presents the largest case series to date on the management of dislocated lenses using iris suturing.Purpose: This study evaluated the long-term outcomes of managing posterior chamber intra-ocular lens (IOL) (PCIOL) subluxation through pars plana vitrectomy (PPV) with IOL iris suturing.Retrospective chart review.Patients who underwent PPV with iris-sutured IOL (IS-IOL) for IOL subluxation between January 2008 and April 2021 at a tertiary center with a minimum of 6 months of follow-up were included. The patients were divided into two groups: those who had prior PPV and those who had not undergone the procedure.A total of 54 patients underwent iris suturing of a subluxated IOL. Among them, 36 (66%) had previously undergone PPV, while 18 patients (33%) had not. The etiology of PCIOL subluxation was uncertain in 20 (37.0%), prior PPV in 17 (32%), and following complicated cataract surgery in 11 (20%) cases. The mean time between original IOL insertion and IS-IOL was 6.1 +/- 7.0 years. The mean follow-up duration was 46.8 +/- 39.7 months. The mean post-operative best corrected visual acuity (BCVA) was logMAR 0.43 +/- 0.52 at final follow-up, a significant improvement from pre-operative BCVA. Vision was significantly better in the group with no prior PPV (logMAR 0.54 +/- 0.59 vs. 0.21 +/- 0.23 at final follow-up, P = 0.026). At final follow-up, 34 (63%) eyes had BCVA of 20/40 or better. The most common complication was cystoid macular edema, attributed to the IS-IOL in 13 (21.4%) eyes, 11 (68.6%) of which resolved or improved.The management of posterior chamber IOL subluxations with PPV and iris suturing of the subluxated IOL is a safe technique that provides excellent long-term visual outcomes.Posterior chamber intra-ocular lens (PCIOL) subluxation is a rare complication following standard phacoemulsification and PCIOL implantation. The reported cumulative risk of post-operative IOL subluxation is 0.1% at 5 and 10 years and 0.2% at 15 years, 0.7% at 20 years, and 1.7% at 20 years.[1] Other studies have reported subluxation rates between 0.3% and 2%.[2-9] PCIOL subluxation can be classified as early if it occurs within 3 months of the initial cataract surgery and late if it occurs any time after 3 months.[2] Early PCIOL subluxation is typically attributed to lens instability within the capsular bag or ruptured zonules, while late subluxation is associated with progressive zonular insufficiency and contraction of the capsular bag.[2] In these cases, the IOL subluxation occurs with the lens still within the capsular bag. Several known risk factors for late-onset PCIOL subluxation include prior pars plana vitrectomy (PPV) or complicated cataract surgery, trauma, myopia, and other causes of zonular insufficiency, such as pseudoexfoliation syndrome.[2,6]There are several potential options for management of PCIOL subluxation, including PPV with PCIOL exchange and placement of a scleral-sutured or transconjunctival scleral-fixated IOL, placement of an anterior chamber IOL (ACIOL), or placement of an iris claw IOL.[3,6,10] However, these methods involve IOL exchange, a time-consuming and costly procedure known to carry risks for the corneal endothelium.[3,6,11,12] An alternative approach that eliminates the need for IOL exchange is PPV with direct suturing of the subluxed PCIOL to the iris.[6,13] This technique has broader applications beyond PCIOL subluxation, including cases of aphakia and ectopia lentis.[3] While scleral-fixated IOLs are more commonly used, iris-sutured IOLs can be an interesting alternative in specific situations.The objective of this study is to assess the long-term outcomes of managing PCIOL subluxations with PPV and suturing of the subluxed PCIOL to the iris. This study evaluates the etiologies of PCIOL subluxation, visual outcomes, and complication rates in patients who underwent this technique. Additionally, we sought to establish potential differences within the sub-cohort of patients having undergone previous PPV. To the best of our knowledge, this study presents the largest case series to date on the management of dislocated lenses using iris suturing.Purpose: This study evaluated the long-term outcomes of managing posterior chamber intra-ocular lens (IOL) (PCIOL) subluxation through pars plana vitrectomy (PPV) with IOL iris suturing.Retrospective chart review.Patients who underwent PPV with iris-sutured IOL (IS-IOL) for IOL subluxation between January 2008 and April 2021 at a tertiary center with a minimum of 6 months of follow-up were included. The patients were divided into two groups: those who had prior PPV and those who had not undergone the procedure.A total of 54 patients underwent iris suturing of a subluxated IOL. Among them, 36 (66%) had previously undergone PPV, while 18 patients (33%) had not. The etiology of PCIOL subluxation was uncertain in 20 (37.0%), prior PPV in 17 (32%), and following complicated cataract surgery in 11 (20%) cases. The mean time between original IOL insertion and IS-IOL was 6.1 +/- 7.0 years. The mean follow-up duration was 46.8 +/- 39.7 months. The mean post-operative best corrected visual acuity (BCVA) was logMAR 0.43 +/- 0.52 at final follow-up, a significant improvement from pre-operative BCVA. Vision was significantly better in the group with no prior PPV (logMAR 0.54 +/- 0.59 vs. 0.21 +/- 0.23 at final follow-up, P = 0.026). At final follow-up, 34 (63%) eyes had BCVA of 20/40 or better. The most common complication was cystoid macular edema, attributed to the IS-IOL in 13 (21.4%) eyes, 11 (68.6%) of which resolved or improved.The management of posterior chamber IOL subluxations with PPV and iris suturing of the subluxated IOL is a safe technique that provides excellent long-term visual outcomes.Posterior chamber intra-ocular lens (PCIOL) subluxation is a rare complication following standard phacoemulsification and PCIOL implantation. The reported cumulative risk of post-operative IOL subluxation is 0.1% at 5 and 10 years and 0.2% at 15 years, 0.7% at 20 years, and 1.7% at 20 years.[1] Other studies have reported subluxation rates between 0.3% and 2%.[2-9] PCIOL subluxation can be classified as early if it occurs within 3 months of the initial cataract surgery and late if it occurs any time after 3 months.[2] Early PCIOL subluxation is typically attributed to lens instability within the capsular bag or ruptured zonules, while late subluxation is associated with progressive zonular insufficiency and contraction of the capsular bag.[2] In these cases, the IOL subluxation occurs with the lens still within the capsular bag. Several known risk factors for late-onset PCIOL subluxation include prior pars plana vitrectomy (PPV) or complicated cataract surgery, trauma, myopia, and other causes of zonular insufficiency, such as pseudoexfoliation syndrome.[2,6]There are several potential options for management of PCIOL subluxation, including PPV with PCIOL exchange and placement of a scleral-sutured or transconjunctival scleral-fixated IOL, placement of an anterior chamber IOL (ACIOL), or placement of an iris claw IOL.[3,6,10] However, these methods involve IOL exchange, a time-consuming and costly procedure known to carry risks for the corneal endothelium.[3,6,11,12] An alternative approach that eliminates the need for IOL exchange is PPV with direct suturing of the subluxed PCIOL to the iris.[6,13] This technique has broader applications beyond PCIOL subluxation, including cases of aphakia and ectopia lentis. [3] While scleral-fixated IOLs are more commonly used, iris-sutured IOLs can be an interesting alternative in specific situations.The objective of this study is to assess the long-term outcomes of managing PCIOL subluxations with PPV and suturing of the subluxed PCIOL to the iris. This study evaluates the etiologies of PCIOL subluxation, visual outcomes, and complication rates in patients who underwent this technique. Additionally, we sought to establish potential differences within the sub-cohort of patients having undergone previous PPV. To the best of our knowledge, this study presents the largest case series to date on the management of dislocated lenses using iris suturing.
