Illustration of IOL refixation with a 25-gauge trocar.

IOL Dislocation? A New Minimally Invasive Fix Could Save Your Vision

Jordan Keane in Health & Wellness December 2025 • 5 min read.

"Researchers pioneer a novel technique using a 25-gauge trocar to refixate dislocated intraocular lenses, reducing complications and improving outcomes."

Intraocular lens (IOL) dislocation, a challenging complication following cataract surgery, can significantly impair vision. This occurs when the artificial lens implanted during cataract surgery shifts out of its intended position, leading to blurred vision, double vision, or other visual disturbances. While IOL dislocation is relatively rare, affecting an estimated 1.7% of post-cataract surgery patients after 25 years, the impact on vision and quality of life can be substantial.

Traditional approaches to correcting IOL dislocation often involve complex surgical procedures, including open-eye techniques that require large corneal incisions. These methods, while effective, carry a higher risk of complications such as infection, astigmatism, and damage to the eye's delicate structures. Therefore, there's a constant drive to refine surgical techniques, seeking safer and less invasive methods to restore proper lens positioning and visual acuity.

Now, a team of researchers has pioneered a novel, minimally invasive technique for IOL refixation, offering new hope for patients experiencing this complication. This innovative approach utilizes a small-gauge trocar, inserted through a tiny incision in the eye, to guide the placement of sutures that secure the dislocated lens back into its correct position. This article explores the details of this groundbreaking technique, its potential benefits, and the positive outcomes observed in a recent study.

A Minimally Invasive Solution: How the 25-Gauge Trocar Technique Works

Illustration of IOL refixation with a 25-gauge trocar.

The study, published in BMJ Open Ophthalmology, details a retrospective case series involving 31 eyes of 31 patients with late IOL dislocation. The innovative technique involves a closed-eye approach, minimizing the need for large incisions and reducing the risk of complications. Here's a breakdown of the procedure:

The procedure leverages a 25-gauge trocar, a tiny, hollow tube, as an intrastromal limbal guide. This trocar is carefully inserted through a small incision in the cornea, allowing the surgeon to pass sutures through the sclera (the white part of the eye) and around the dislocated IOL.

Anterior Vitrectomy: If necessary, an anterior vitrectomy (removal of vitreous gel from the front of the eye) is performed to clear the visual axis and provide better access to the IOL.
Scleral Fixation: Using the 25-gauge trocar as a guide, a 10/0 polypropylene suture is passed through the sclera, around the haptic (the supporting arm) of the IOL, and back out through the sclera. This creates a secure anchor point.
Precise Positioning: The surgeon carefully tensions and knots the suture, ensuring the IOL is properly centered and stabilized within the eye.
Minimally Invasive: This technique avoids large corneal incisions, reducing the risk of induced astigmatism and other complications associated with open-eye procedures.

By using the trocar as a guide, the surgeon can precisely place the sutures without causing excessive trauma to the surrounding tissues. This approach is particularly beneficial in cases where the IOL is only partially dislocated, or where there are concerns about the integrity of the corneal tissue.

Promising Results: Restoring Vision and Minimizing Risks

The study's findings demonstrate the effectiveness and safety of this novel technique. The results showed a significant improvement in visual acuity among the patients who underwent the procedure. The average preoperative best-corrected visual acuity (BCVA) was 0.73 LogMar, which improved to 0.27 LogMar postoperatively. This indicates a substantial enhancement in vision for the majority of patients.

Moreover, the complication rate associated with the 25-gauge trocar technique was low. While some patients experienced minor issues such as elevated intraocular pressure or cystoid macular edema, these were generally manageable with medication or resolved on their own. Importantly, none of the patients experienced severe complications such as retinal detachment, choroidal detachment, or endophthalmitis.

This innovative approach offers a valuable alternative to traditional IOL refixation techniques, particularly for patients with certain types of IOL dislocation. By minimizing the invasiveness of the procedure, surgeons can reduce the risk of complications, improve visual outcomes, and enhance the overall patient experience. As the technique gains wider adoption, it has the potential to transform the management of IOL dislocation and restore clear vision for countless individuals.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.1136/bmjophth-2018-000174, Alternate LINK

Title: Intraocular Lens Dislocation: A Novel In-Situ Scleral Refixation Technique Using A 25 Gauge Trocar In The Anterior Chamber

Subject: Ophthalmology

Journal: BMJ Open Ophthalmology

Publisher: BMJ

Authors: Fabrizio Giansanti, Ruggero Tartaro, Tomaso Caporossi, Vittoria Murro, Alfonso Savastano, Francesco Barca, Daniela Bacherini, Tito Fiore, Carlo Cagini, Stanislao Rizzo

Published: 2018-11-01

Everything You Need To Know

What exactly is IOL dislocation, and why does it happen after cataract surgery?

IOL dislocation occurs when the intraocular lens, which is an artificial lens implanted during cataract surgery, shifts out of its intended position. This can lead to blurred vision, double vision, or other visual disturbances. While relatively rare, affecting about 1.7% of post-cataract surgery patients after 25 years, it can significantly impact vision and quality of life. Traditional corrections often involved complex surgical procedures with larger incisions, increasing risks such as infection and astigmatism.

How does this new minimally invasive technique using a 25-gauge trocar actually work to fix a dislocated IOL?

The minimally invasive technique uses a 25-gauge trocar, a small, hollow tube, as an intrastromal limbal guide. It's inserted through a tiny incision in the cornea to pass sutures through the sclera and around the dislocated intraocular lens. If needed, an anterior vitrectomy is performed first. Sutures are then passed through the sclera, around the haptic of the intraocular lens, and back out through the sclera, creating a secure anchor. The surgeon then carefully tensions and knots the suture to properly center and stabilize the intraocular lens.

What is an anterior vitrectomy, and why is it sometimes necessary during IOL refixation?

Anterior vitrectomy involves the removal of vitreous gel from the front of the eye. This is done to clear the visual axis and provide better access to the intraocular lens during the refixation procedure. By removing the vitreous gel, the surgeon gains a clearer view and more working space to manipulate and secure the dislocated intraocular lens. This step is crucial for ensuring the precise placement of sutures and the overall success of the procedure. While the text does not mention if an anterior vitrectomy is always required, it is performed only if necessary.

What kind of visual improvement can patients expect after undergoing this 25-gauge trocar IOL refixation procedure?

The study showed a significant improvement in visual acuity among patients who underwent the 25-gauge trocar technique. The average preoperative best-corrected visual acuity (BCVA) was 0.73 LogMar, which improved to 0.27 LogMar postoperatively. This demonstrates a substantial enhancement in vision for the majority of patients. The key is the less invasive approach means less risk of induced astigmatism and other complications that are associated with open-eye procedures.

Are there other methods to fix a dislocated intraocular lens, and how does this new technique compare to those options?

While the described technique focuses on the use of a 25-gauge trocar for scleral refixation of dislocated intraocular lenses, other methods exist. Traditional surgical approaches often involve larger corneal incisions and more invasive techniques, which carry higher risks of complications. Other sutureless techniques and alternative fixation methods may also be employed depending on the specific circumstances of the IOL dislocation and the surgeon's expertise. Future advancements may explore even less invasive options or improved suture materials for enhanced long-term stability.