Glaucoma and Intraocular Pressure in Patients Operated for Late In-the-bag Intraocular Lens Dislocation: A Randomized Clinical Trial

Abstract

To compare intraocular pressure (IOP) and IOP-lowering treatment requirements in patients with late in-the-bag intraocular lens (IOL) dislocation operated with 2 different methods, and to assess whether an IOP decrease after surgery can be expected. Prospective, randomized, parallel-group clinical trial. In our university clinic, 104 patients (eyes) were randomly assigned to IOL repositioning by scleral suturing (n= 54) or IOL exchange with a retropupillar iris-claw lens (n= 50). The main outcome measure was 6-month postoperative IOP change. Overall IOP was 18.0 ± 6.2mm Hg before surgery and 15.7 ± 4.8mm Hg 6months after surgery (P < .001). IOP changed by-1.2 ± 5.8mm Hg (P= .18) in the Repositioning group and-3.8 ± 6.4mm Hg (P < .001) in the Exchange group (group difference: P= .05). Before surgery, 62 patients had either preexisting glaucoma (n= 39) or high IOP (≥22mm Hg) with suspected glaucoma (n= 23), of whom several required preoperative IOP-lowering treatment. In the postoperative period, 28% and 21% of the patients in each operation group, respectively, required IOP-lowering treatment with glaucoma medications added, adjunctive laser trabeculoplasty, cyclodiode laser, or filtering surgery. Only 0 and 3 patients, respectively, discontinued their IOP-lowering medication. This trial showed an IOP decrease after late in-the-bag IOL dislocation surgery that seemed to be more pronounced with IOL exchange. However, associated high IOP was not resolved by dislocation surgery in many patients, and increased IOP-lowering treatment in the postoperative course was commonly required.