Tactical approaches to surgical management of lens subluxation

A proper treatment of crystalline lens subluxation presents one of the greatest challenges in ophthalmic surgery. To deliver the best possible outcomes a surgeon is required to assess adequately preoperative data findings to devise a general surgical plan. Taking into account the large variability of the clinical picture observed in this category of patients, it is also necessary to provide several alternative tactics.A basis of contemporary approaches to ectopic lens extraction strongly focuses on minimally invasive phacoemulsification techniques. The essence of innovative thinking in this field could be described as capsular bag preservation for endocapsular placement of intraocular lenses (IOLs). With this ultimate goal in mind, various technical tricks and a multitude of devices ranging from plastic hooks to femtosecond lasers were introduced. A thorough understanding of the modern armamentarium of surgical techniques and implants would be beneficial to a surgeon to be maximally prepared to numerous problems and challenges specific to lenses with compromised zonular support. Bringing non-standard situations of lens subluxation to the regular in-the-bag IOL placement, even though highly preferable, could not be assured in every case.The second part of the review article provides information on alternative strategies for the IOL fixation – from historical and little relevant today methods to the latest i nnovations in the field.