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Intraocular lens repositioning

In rare circumstances, Nd:YAG laser photodisruption can be used to manipulate the position of an IOL. The pressure wave from optical breakdown can shift an IOL optic if the optic is sufficiently mobile.

One special case is illustrated in Figure 52-18A. A previously well-centered ciliary sulcus-fixated PC IOL became captured in the pupil after pupillary dilation. The pupil could not be redilated beyond the border of the IOL optic. Mechanical manipulation of the IOL optic by placing the patient in the supine position or with pressure of a cotton-tipped applicator over the ciliary sulcus failed to cause the IOL optic to shift posteriorly.

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A 6mJ pulse from an Nd:YAG laser was then applied to the peripheral edge of the IOL. The laser was focused just anterior to the anterior IOL surface. This anterior pressure wave caused the IOL optic to shift posteriorly, just behind the pupillary sphincter. The sphincter was then constricted with pilocarpine, successfully …