Management of Posteriorly Dislocated Crystalline Lens in Low-Income Settings With Needle Levitation and Scleral Tunnel Expression Technique

Purpose: To describe a novel surgical technique for managing posteriorly dislocated crystalline lens in low-income settings, which involves levitation of the lens with a 25-gauge needle and subsequent lens expression through a scleral tunnel. Methods: A superior self-sealing scleral tunnel of 8 mm length is created without entering the anterior chamber. A complete 23-gauge 3-port pars plana vitrectomy is performed. After vitrectomy completion, the scleral tunnel is opened. A 25-gauge bent needle is introduced in the vitreous cavity and used to elevate the crystalline lens above the iris plane, which is prolapsed into the anterior chamber. After viscoelastic injection, the lens is expressed en bloc through the scleral tunnel with a vectis. Peripheral retinal indented examination is performed. If indicated, a secondary intraocular lens (anterior chamber, iris-claw or scleral-fixated) is implanted. Results: This technique achieves complete removal of a dropped crystalline lens without the need of a phaco-fragmatome or perfluorocarbon liquid. The levitation of the lens with a 25-gauge needle minimizes intraocular manipulations, and the self-sealing scleral tunnel eliminates the need for sutures. Conclusion: This technique is a practical and reproducible approach for managing posteriorly dislocated crystalline lenses in resource-limited settings. It offers a cost-effective solution suitable for widespread adoption in similar environments.