Spontaneous Intraocular Lens Dislocation Research Articles

LONG-TERM OUTCOMES OF SUTURELESS INTRASCLERAL INTRAOCULAR LENS FIXATION IN CHILDREN AND ADULTS: Single-Surgeon Case Series With and Without Haptic Flanging With Up to 11 Years of Follow-Up.

Report and compare long-term outcomes and complications of sutureless scleral tunnel (SST) and flanged haptic (FH) scleral-fixated intraocular lens, with spontaneous intraocular lens (IOL) dislocation as primary outcome measure. Retrospective single-surgeon case series of 95 SST and 458 FH eyes from 2011 to 2022 (553 total eyes). Demographics, surgical indications, ocular history, visual acuity, and complication rates were collected. Reoperation-requiring spontaneous IOL dislocation rate was significantly different ( P = 0.0167) between FH (3.7%) and SST (10.5%). Mean follow-up was 3.31 ± 0.30 versus 1.58 ± 0.07 years for SST and FH, respectively. There was no significant difference between preoperative (20/305 vs. 20/300) or final postoperative (20/77 vs. 20/62) visual acuity. Other complications included any cystoid macular edema (20.0% vs. 25.3%), elevated intraocular pressure (16.8% vs. 9.6%), IOL tilt requiring reoperation (5.3 vs. 0%), haptic exposure (2.1% vs. 3.3%), and reverse pupillary block (4.2% vs. 1.1%). Haptic flanging resulted in fewer eyes meeting the primary end point of IOL dislocation. We reported the longest-to-date follow-up of both nonflanged SST IOL fixation and our FH-modified Yamane technique. Our FH-modified Yamane technique represents a safe, durable, and potentially superior option for scleral-fixated intraocular lens.

CYSTOID MACULAR EDEMA AFTER FOUR-POINT SCLERAL FIXATION OF INTRAOCULAR LENS.

To assess the incidence of cystoid macular edema (CME) associated with 4-point Gore-Tex suture intraocular lens (IOL) scleral fixation, before and after institution of routine intravitreal triamcinolone acetonide prophylaxis and long-term topical nonsteroidal anti-inflammatory drug usage. Consecutive patients were included after IOL implantation with concurrent pars plana vitrectomy for spontaneous IOL dislocation due to pseudoexfoliation syndrome. We compared short-term prophylactic nonsteroidal anti-inflammatory drugs only (Group A) to prophylactic intravitreal triamcinolone acetonide and long-term nonsteroidal anti-inflammatory drugs (Group B). Twenty-six eyes of 26 patients with pseudoexfoliation syndrome and spontaneous IOL dislocation were studied. Mean logMAR visual acuity improved from 1.27 ± 0.80 (20/375 Snellen equivalent) preoperatively to 0.46 ± 0.39 (Snellen 20/43) postoperatively (P < 0.001). Visual outcomes were similar for Groups A and B. In Group A, 10/16 eyes had CME, 4/16 had chronic CME longer than 6 months, and 1 longer than 12 months. In Group B, 1/10 had CME (which was both chronic and refractory). In eyes with pseudoexfoliation syndrome and spontaneous IOL dislocation, 4-point Gore-Tex suture IOL ab externo fixation yielded good visual outcomes, although CME was observed more than reported elsewhere. Prophylactic intravitreal triamcinolone acetonide and long-term nonsteroidal anti-inflammatory drugs seem to reduce the risk of postoperative CME.

Case Report: Diagnosis of Late Spontaneous Intraocular Lens Dislocation on Point-of-care Ultrasound.

IntroductionSpontaneous intraocular lens (IOL) dislocation is a rare, but serious, complication following cataract surgery.Case ReportWe report a case of patient with a remote history of cataract surgery presenting to the emergency department with monocular blurred vision. Ocular point-of-care ultrasound (POCUS) facilitated diagnosis of a late spontaneous IOL dislocation.DiscussionProsthetic IOL dislocations are being reported with increasing frequency. Prompt recognition of IOL dislocation is essential to prevent secondary complications, including acute angle-closure glaucoma and retinal detachment, which can result in permanent vision loss.ConclusionPoint-of-care ultrasound is a rapid, noninvasive imaging modality for early detection of IOL dislocation to help guide management, improve patient outcomes, and mitigate long-term sequelae.

Частота спонтанной дислокации комплекса «интраокулярная линза – капсульный мешок» в различные сроки послеоперационного периода факоэмульсификации возрастной катаракты

Purpose . To study frequency of spontaneous dislocation of intraocular lens – capsular bag complex in various periods after phacoemulsification (PE) of age-related cataracts, develop its clinical classification based on objective criteria for gradation of degrees of severity. Material and methods . All cases of intraocular lens – capsular bag complex dislocation occurred in our clinic in different periods after PE of age-related cataract in 2010–2018 were selected. 24231 PE of agerelated cataract were performed in our clinic during this period. The proportion of spontaneous dislocations of intraocular lens – capsular bag complex having non-traumatic origin was at least 0.26%. We carried out retrospective analysis of the possible causes of spontaneous dislocation of intraocular lens – capsular bag complex in these patients. Results . All 63 patients with dislocation of intraocular lens – capsular bag complex presented themselves to the clinic. There were 39 men and 24 women. Their age ranged from 50 to 89. The time of formation of intraocular lens – capsular bag complex dislocations was conditionally estimated according to the data presented by the patients. It varied widely from 3 months to 14 years, averaging 5.45±3.6 years. In the course of time after performing PE, the frequency of dislocation progressively increased. Conclusion . The criteria for the presence and severity of spontaneous dislocation of intraocular lens – capsular bag complex was: 1) severity of dislocation of intraocular lens – capsular bag complex from its correct anatomical position, based on biomicroscopy, 2) uncorrected visual acuity, 3) intraocular pressure, 4) risk of intraocular complications. Our in-depth clinical analysis of the severity of postoperative dislocation of intraocular lens – capsular bag complex allowed us to create simple and affordable clinical classification of this condition.

Evaluation of Flanged Haptics Intrascleral Sutureless Intraocular Lens Fixation

Background: successful intraocular lens (IOL) placement in patients undergoing cataract surgery has become synonymous with the IOL being placed in the capsular bag. Purpose: to evaluate the flanged haptic sutureless intrascleral intraocular lens fixation with double needle technique as a method of scleral fixation of posterior chamber IOL (PCIOL) as regard to its stability and safety as well as its complications. Patients and Methods: this is a prospective study, which included 20 eyes of 20 patients with aphakia with no adequate capsular support. Results: post-operatively the best corrected visual acuity (BCVA) was improved to reach up to 0.8 decimal unit. Intra-operatively, haptic breakage was reported in 3 cases where the IOLs were explanted and new IOLs were implanted and sclerally fixated. The post-operative complications included iris capture in 2 cases (10%), haptic deformation in 2 cases (10%), exposure in 5 cases (25%) and slippage in 2 cases (10%), corneal edema in 6 cases (30%), IOL decentration in 4 cases (20%) one of them was significantly decentered and needed for reoperation where one point fixation by a stitch of the slipped haptic , spontaneous IOL dislocation in 2 cases (10%) 1 month and 3 months post-operatively, both required re operation where the slipped IOL was explanted and new one is re implanted and sclerally fixated. There were no incidents of post-operative ciliary body injury, retinal tear or detachment or endophthalmitis. Conclusions: the flanged haptics intrascleral sutureless IOL fixation with double needle technique can be done for aphakic cases with no adequate capsular support.

Late Spontaneous Posterior Dislocation of Intraocular Lens (IOL) - Case Report

Cataract surgeries have undergone a great evolution over a period of time. This evolution helped in reducing the overall rate of spontaneous dislocation of Intra Ocular Lens (IOL) and provide a standard management for cataracts. Until in recent times, cases have been reported with spontaneous dislocation of IOL. This spontaneous dislocation of the intra ocular lens (IOL) with intact capsular bag can be typically seen in conditions resulting from zonular insufficiency and zonulysis [1]. This has usually been associated with conditions like, posterior capsular rent, post ND: YAG laser, trauma, pseudo exfoliation, myopia and other risk factors [2-5]. Although, IOL dislocation can occasionally occur in a spontaneous manner without any predisposing factors [5-10].

Comparison of outcomes of scleral fixation with and without pars plana vitrectomy for the treatment of dislocated intraocular lens.

To investigate the surgical outcomes of scleral fixation with either pars plana vitrectomy (ppV) or anterior vitrectomy (AV) for the treatment of dislocated intraocular lens (IOL). By retrospective review of electronic medical records, patients with in-the-bag spontaneous IOL dislocation who underwent IOL exchange with scleral fixation were included and grouped according to the vitrectomy method: ppV (group 1) and AV (group 2). Post-operative surgical outcomes including visual acuity (log MAR), spherical equivalent, and surgically induced astigmatism (SIA) and complications were investigated and analyzed. After 6months, post-operative measurements showed an average visual acuity of 0.16±0.20, spherical equivalent of -1.48±1.53D (diopters), and refractive shift of -0.19±0.44D in group 1 (n=19). There was no statistically significant difference between the measurements of group 1 and group 2 (n=20) (0.10±0.12, -2.00±1.71D, -0.39±0.57D, respectively) (p=0.51, p=0.29, p=0.16, respectively). When analyzed by the algebraic and vector methods, group 1 did show a higher magnitude of surgically induced astigmatisms (1.61±1.50D, 2.10±1.03D, respectively) than did group 2 (0.49±1.02D, 1.31±0.83D respectively) (both p's=0.01). There was no significant difference in the incidence of complications except for vitreoretinal complications, which were higher in group 2 (25%), compared with group 1 (0%) (p=0.047). Both ppV and AV are appropriate options in patients who need IOL exchange with scleral fixation based on visual outcomes, refractive shifts, and complication rates. In terms of managing astigmatism, the AV procedure may be the better option.

Late Spontaneous Dislocation of a Posterior Chamber Intraocular Lens into Anterior Chamber: A Case Report

Abstract Introduction: Lens luxation generally happens secondary to trauma and hereditary disorders into the vitreous body. However, spontaneous dislocation especially into the anterior chamber occurs rarely. We report an unusual case with spontaneous anterior dislocation of a posterior chamber intraocular lens (IOL) 4 years after cataract surgery. Case Presentation: A 42-year-old woman was referred to ophthalmology department with complaint of sudden onset blurring of vision in the left eye 4 years after cataract surgery. No history of trauma and systemic disorder was reported and no capsular fibrosis was found during eye examination. The patient underwent corneoscleral incision under general anesthesia and the IOL was extracted using a viscoelastic material. Conclusions: To our knowledge, this is the first reported case in the literature. This report may imply that IOL related factors could be considered for spontaneous dislocation of intraocular lenses.

Sutureless intrascleral intraocular lens fixation with lamellar dissection of scleral tunnel.

PurposeTo report the results of sutureless scleral fixation of a posterior chamber intraocular lens (IOL) by using our developed simple technique.MethodsWe retrospectively reviewed the medical records of 48 eyes of 47 patients who underwent sutureless intrascleral IOL fixation by using our modified technique. A 25-gauge microvitreoretinal knife was used to perform sclerotomies and create limbus-parallel scleral tunnels with lamellar dissection in which the haptics were fixed.ResultsThe IOLs were fixed and centered well. The mean follow-up period was 26.7 months. Postoperative complications included smooth vitreous hemorrhage in four eyes (8.3%), cystoid macular edema in two eyes (4.2%), and iris capture of the IOL in two eyes (4.2%). No other complications, such as breakage of the IOL, spontaneous IOL dislocation, or retinal detachment, were detected during the follow-up period.ConclusionThe lamellar dissection of the limbus-parallel scleral tunnel can simplify the forceps-assisted introduction of the haptics into the scleral tunnel, and this technique seemed to be safe.

Bilateral spontaneous dislocation of posterior chamber intraocular lens in a patient with gyrate atrophy

We report a patient with gyrate atrophy, a rare metabolic disease, who had bilateral late spontaneous posterior dislocation of in-the-bag posterior chamber intraocular lens (PCIOL). He underwent pars plana vitrectomy, PCIOL retrieval and anterior chamber intraocular lens implantation in both eyes. This report may imply that patients with gyrate atrophy are at risk for spontaneous dislocation of intraocular lenses.

Spontaneous dislocation of intraocular lens as a late complication of uncomplicated cataract surgery: a case series

Five patients having uncomplicated phacoemulsification were implanted with CT‐Asphina 603P intraocular lenses into the capsular bag. After a few months, three of the patients had haptic flexion anterior to the optic despite minimal capsular fibrosis. One patient had spontaneous dislocation of the intraocular lens into the anterior chamber with only minimal capsular fibrosis. Another patient had one haptic dislocated out of the bag.Late intraocular lens dislocation is also seen in newly designed preloaded intraocular lenses despite the absence of significant capsular fibrosis. Haptic‐optic junction design and intraocular lens material play important roles in such complication. A slightly large capsulorhexis might be a deterrent for implantation of this intraocular lens.

Subluxationsserie eines hydrophilen Kunstlinsentyps nach umkomplizierter Phakoemulsifikation

As techniques for cataract surgery have evolved, spontaneous intraocular lens (IOL) dislocation in patients with no ocular pathology arises less frequently. We present seven consecutive cases of uncomplicated cataract surgery with early in-the-bag spontaneous intraocular lens dislocation for which the same type of hydrophilic single piece lens was used. A retrospective analysis was conducted on seven cases involving patients with IOL dislocation who underwent uncomplicated cataract surgery within a period of 4 months (October 2010 to January 2011) using the same type of single piece IOL. The median age of the 7 patients was 73 years and IOL repositioning was performed after an average of 10 weeks. Sulcus repositioning could be carried out in only five of the seven patients and IOL repositioning within the capsule was achieved in one patient. A second patient exhibited IOL dislocation after yttrium aluminium garnet (YAG) laser capsulotomy. Explantation of the IOL and sulcus implantation of another IOL type (Acrysof MA50MB) was necessary for a third patient. A fourth case presented an angled IOL haptic and dislocation of the IOL in the sulcus position. Even after uncomplicated cataract surgery, spontaneous in-the-bag IOL dislocation in patients with no ocular pathology may occur due to a hydrophilic lens material which induces stronger anterior capsular phimosis (ACP) in comparison to alternative materials. In combination with a thin lens design this may result in angled IOL haptics and IOL dislocation. Careful selection of suitable lens design and material according to individual predisposing factors is necessary. This retrospective case study demonstrates that the combination of hydrophilic lens material and a thin lens design may result in early spontaneous IOL dislocation. Furthermore, as established in one case, YAG laser capsulotomy may induce IOL dislocation if the lens design cannot withstand capsular fibrosis.

Late In-the-Bag Spontaneous Intraocular Lens Dislocation: Evaluation of 86 Consecutive Cases

As techniques for cataract surgery have evolved, spontaneous intraocular lens (IOL) dislocation has decreased overall. However, since 2006 the Intermountain Ocular Research Center has received an increased number of explanted IOLs within the capsular bag forwarded for pathologic evaluation. Late, spontaneous dislocation of IOLs results from zonular insufficiency and zonulysis that has been associated with pseudoexfoliation, trauma, and other risk factors. The findings of 86 consecutive cases of this complication, analyzed in the laboratory, are described. Retrospective case series. Eighty-six IOLs explanted within the capsular bag, submitted in formalin. Standard light microscopy of specimens, as well as questionnaire sent to explanting surgeons and patient chart review, when available. Lens design, material, and abnormalities; capsular bag anomalies; patient demographic data; surgical dates; and presence or absence of known risk factors. This series included polymethyl methacrylate, silicone, and hydrophobic acrylic lenses, manufactured with both 1-piece and 3-piece designs. The mean time from surgery to spontaneous IOL dislocation was 8.5 years. The main conditions associated with the cases of IOL dislocation were as follows: pseudoexfoliation, 50%; prior vitreoretinal surgery, 19%; history of trauma, 6%; uveitis, 2%; and none or unknown, 23%. Patients with any type of IOL are at risk for late in-the-bag dislocation. Pseudoexfoliation and vitreoretinal surgery were the most common associated conditions in this series. Regardless of the presence of known risk factors, IOLs dislocated on average 8.5 years after phacoemulsification and IOL implantation.

Spontaneous late dislocation of intraocular lens within the capsular bag in pseudoexfoliation patients

Purpose To identify a delayed complication of cataract surgery in patients with zonular weakness caused by pseudoexfoliation syndrome. Design Retrospective observational case series. Participants Eight eyes in seven patients with clinically diagnosed pseudoexfoliation syndrome who had undergone previous uncomplicated cataract extraction and placement of a posterior chamber intraocular lens. Methods This study evaluated eight cases of late spontaneous dislocation of posterior chamber intraocular lenses within the capsular bag in patients with pseudoexfoliation syndrome. Data were gathered retrospectively from patients’ operative reports, medical records, and pathology reports. Main outcome measures (1) Interval between original surgery and dislocation; (2) final best-corrected visual acuity and ocular outcome. Results All patients had a diagnosis of pseudoexfoliation syndrome and had previously undergone uncomplicated cataract surgery. No patient had any other predisposing factors that would lead to zonular dehiscence or weakness. Delayed dislocation of the entire capsular bag containing the intraocular lens (IOL) occurred spontaneously in all cases. Mean time from IOL implantation to dislocation was approximately 85 months (7 years and 1 month; range, 57–115 months) after surgery. Seven eyes were treated successfully with IOL exchange: six with placement of an anterior chamber IOL and one with scleral fixation of a posterior chamber IOL. The remaining case was treated by scleral fixation of the dislocated IOL. Gross pathology analysis of seven cases confirmed the presence of the IOL within the intact capsular bag. Six eyes have achieved final best-corrected visual acuity of 20/40 or better. Conclusion Patients with pseudoexfoliation syndrome may be at risk for delayed spontaneous dislocation of IOL within the capsular bag after uncomplicated cataract surgery. Awareness of this newly recognized long-term complication may justify a reevaluation of surgical considerations for cataract removal in these patients.

Late onset lens particle glaucoma as a consequence of spontaneous dislocation of an intraocular lens in pseudoexfoliation syndrome

PURPOSE: To report acute onset lens particle glaucoma associated with pseudoexfoliation-related dislocation of an intraocular lens implant 12 years after cataract surgery. METHODS: Case report. RESULTS: An 80-year-old woman presented with acute onset of left eye pain that was associated with white fleck-like particles circulating in the anterior chamber and an intraocular pressure of 48 mm Hg. The posterior chamber intraocular lens within the capsular bag was positioned more posteriorly to the iris plane than usual, and pseudoexfoliative material was present on the lens capsule and the zonules. Anterior chamber aspirate confirmed the presence of lens cortical fibers. CONCLUSION: Spontaneous dislocation of the posterior chamber intraocular lens in patients with pseudoexfoliation syndrome several years after cataract surgery may liberate lens cortical material, causing lens particle glaucoma.