Tackling Macular Edema and Dislocated Intraocular Lens: The Fluocinolone-loaded IOL With Scleral Suspension (FLISS) Technique

This report presents the fluocinolone-loaded intraocular lens (IOL) with scleral suspension (FLISS) technique as a surgical approach for managing macular edema (ME) in patients with compromised lens-iris diaphragm and dislocated IOL. A 74-year-old woman with a subluxated bag-IOL complex and chronic ME underwent pars plana vitrectomy. After IOL removal, Gore-Tex CV-8 sutures were used to secure a 0.19-mg fluocinolone acetonide (FAc) intravitreal implant (Iluvien) to the haptic of a Micro-pure IOL and subsequently fix the lens to the sclera. Three months later, visual acuity had improved from 20/160 to 20/50, and there was no ME. The FAc implant remained stable and well positioned outside the visual axis. The FLISS technique, herein described for the first time, offers a promising alternative for addressing chronic ME in eyes requiring secondary IOL implantation, with the benefits of no additional scleral manipulation (compared to standard IOL scleral fixation) and low risk of implant migration.