Epidemiology, Etiology, and Prevention of Late IOL-Capsular Bag Complex Dislocation: Review of the Literature

Andrzej Grzybowski,Valentín Huerva,Francisco J Ascaso

doi:10.1155/2015/805706

Abstract

Posterior chamber intraocular lens (PC-IOL) subluxation is uncommon but represents one of the most serious complications following phacoemulsification. Late spontaneous IOL-capsular bag complex dislocation is defined as occurring three months or later following cataract surgery. Unlike early IOL dislocation, late spontaneous IOL dislocation is due to a progressive zonular dehiscence and contraction of the capsular bag many years what seemed to be uneventful surgery. In recent years, late in-the-bag IOL subluxation or dislocation has been reported with increasing frequency, having a cumulative risk of IOL dislocation following cataract extraction of 0.1% after 10 years and 1.7% after 25 years. A predisposition to zonular insufficiency and capsular contraction is identified in 90% of reviewed cases. Multiple conditions likely play a role in contributing to this zonular weakness and capsular contraction. Pseudoexfoliation is the most common risk factor, accounting for more than 50% of cases. Other associated conditions predisposing to zonular dehiscence are aging, high myopia, uveitis, trauma, previous vitreoretinal surgery, retinitis pigmentosa, diabetes mellitus, atopic dermatitis, previous acute angle-closure glaucoma attack, and connective tissue disorders. The recognition of these predisposing factors suggests a modified approach in cases at risk. We review certain measures to prevent IOL-bag complex luxation that have been proposed.

Highlights

Cataract surgery with intraocular lens (IOL) implantation is a successful surgical procedure which has dramatically improved because of development in new techniques and devices, making it safer than it was two decades ago [1]
Unlike early IOL dislocation, late spontaneous IOL dislocation is due to a progressive zonular dehiscence and contraction of the capsular bag many years what seemed to be uneventful surgery
Other associated conditions predisposing to zonular dehiscence are aging, high myopia, uveitis, trauma, previous vitreoretinal surgery, retinitis pigmentosa, diabetes mellitus, atopic dermatitis, previous acute angle-closure glaucoma attack, and connective tissue disorders

Summary

Introduction

Cataract surgery with intraocular lens (IOL) implantation is a successful surgical procedure which has dramatically improved because of development in new techniques and devices, making it safer than it was two decades ago [1]. IOLs seem to be dislocated in a bimodal distribution These dislocations are divided into early and late cases (Table 1) [4]. In contrast to early lens dislocation, bag dislocation generally occurs as a result of progressive zonular weakness many years after even uncomplicated cataract surgery, not from inadequate fixation of the IOL [5, 9]. [1] retrospectively analyzed all the patients who were treated for late IOL dislocation requiring surgical management after routine cataract surgery was performed. They found that late IOL dislocation after phacoemulsification was mostly of the in-the-bag type, with late out-of-thebag dislocation in only 12.1% of the cases

Incidence and Distribution of Late IOL Dislocation

Proposed Mechanisms in the Etiology of Late IOL Dislocation

Risk Factors

Findings

Prevention