Abstract
PurposeThe aim of this study was to examine the recent status of intraocular lens (IOL) dislocation according to a classification system based on vertical dislocation position, as well as the surgical techniques and outcomes of IOL exchange surgery.MethodsThe medical records of 230 eyes from 214 consecutive patients who experienced IOL dislocation and underwent exchange surgery between 2006 and 2014 were reviewed. Vertical dislocation sites observed preoperatively under operating microscopy were examined, along with the surgical techniques and outcomes of IOL exchange.ResultsDislocation sites included (1) the anterior chamber (12.2 %), (2) pseudophakodonesis (19.1 %), (3) the anterior vitreous cavity (47.4 %), (4) trap door-like dislocation (dangling in the peripheral vitreous cavity; 16.1 %), and (5) the retinal surface (5.2 %). The IOL retained in the anterior segment was moved onto the iris by pulling it up through the limbal side ports with an anterior vitrectomy (67.8 %), or by pushing it up from the pars plana with an anterior vitrectomy (26.5 %), while the IOL dropped on the retina was lifting it up from the retina after pars plana vitrectomy (5.7 %). Mean uncorrected and distance-corrected visual acuity significantly improved postoperatively (p < 0.0001). Major complications included a marked elevation in intraocular pressure (7.8 %), pupillary capture (6.5 %), and vitreous hemorrhage (2.6 %).ConclusionsBased on the classification system, approximately 95 % of dislocated IOLs were retained in the anterior segment, and these IOLs were exchanged using an anterior approach through limbal incisions with an anterior vitrectomy. Visual acuity improved significantly, and serious complications were uncommon, probably because the IOL exchange techniques were standardized and simplified without pars plana vitrectomy.
Highlights
Late dislocation of an intraocular lens (IOL) is a serious complication after cataract surgery [1,2,3,4]
Of the 269 eyes that consecutively underwent IOL exchange surgery for dislocation, 39 eyes were excluded from analysis; 14 were eyes that underwent IOL exchange for reasons other than IOL dislocation, 12 were eyes that underwent combined surgery with other surgeries, including penetrating keratoplasty or glaucoma surgery, nine were eyes that underwent IOL exchange without scleral fixation, one eye that underwent corneal transplantation, one eye that underwent repositioning with suturing to the sclera, and two eyes that were lost to follow-up
No statistically significant differences were found between the in-the-bag and out-of-thebag dislocation groups with regard to age, sex, ratio of left to right eyes, time interval between cataract surgery and IOL exchange surgery, corneal astigmatism, or corrected visual acuity (VA)
Summary
Late dislocation of an intraocular lens (IOL) is a serious complication after cataract surgery [1,2,3,4]. Many surgical techniques are applied to management of dislocated IOLs, including exchanging or repositioning of the IOL with suturing to the sclera or iris, which is performed with a pars plana vitrectomy or an anterior vitrectomy [5,6,7,8,9,10,11,12,13,14,15]. Posterior segment surgeons prefer the posterior approach with repositioning of the IOL and pars plana vitrectomy [5,6,7,8,9,10,11,12,13], while anterior segment surgeons prefer the anterior approach with exchange of the IOL through limbal incisions and anterior vitrectomy [4, 14, 15]. IOL repositioning procedures have recently gradually decreased, and IOL exchange procedures have become the predominant technique
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