Purpose To investigate intraocular pressure in eyes with intraocular lens subluxation and pseudoexfoliation syndrome. Methods In this retrospective study conducted at one eye centre (tazz) in Zurich, Switzerland, we reviewed 85 eyes with intraocular lens subluxation and pseudoexfoliation syndrome. Intraocular lens exchange was carried out by two surgeons between 03/2016 and 12/2019 (45 months). Information on baseline characteristics and diagnosis of glaucoma was recorded. Intraocular pressure and best-corrected visual acuity were analysed preoperatively and at five time points up to 12 months after lens exchange. Data on antiglaucomatous medication was collected before surgery and at two different time points after surgery. Postoperative pressure lowering procedures and complications were further analysed. Results This study includes 85 pseudoexfoliation eyes with intraocular lens subluxation. The mean interval between cataract surgery and lens exchange was 8.9 ± 5.2 years. Intraocular pressure elevation in the event of intraocular lens subluxation was found in 54% (46/85) of eyes. Mean intraocular pressure decreased from 22.9 ± 9.4 mmHg preoperatively to 15.2 ± 3.4 mmHg at follow-up 12 months after lens exchange (p < 0.001). Postoperative topical antiglaucomatous drug requirements were comparable to preoperative levels (p = 0.520). Less systemic acetazolamide was required 12 months postoperatively (p = 0.018). A pressure lowering procedure was required in seven (8%) eyes in the postoperative period due to persistence of high intraocular pressure. Intermittent increase or persistence of high intraocular pressure occurred in 13 (15%) eyes. Conclusion This study emphasises the connection between acute pressure elevation and intraocular lens subluxation in patients with pseudoexfoliation syndrome. Intraocular pressure decreases after lens exchange and decrease sustains for a postoperative period of 12 months. Postoperative pressure lowering procedures were not required in the majority of eyes. We therefore conclude that intraocular lens exchange is efficient in the management of lens subluxation and pressure elevation in patients with pseudoexfoliation syndrome.

Purpose To compare the efficacy and safety of core vitrectomy and pars plana vitrectomy for lens exchange in patients with intraocular lens dislocation. Methods This is a retrospective study conducted at one eye center in Zurich, Switzerland. We reviewed 124 eyes with dislocated intraocular lens undergoing lens exchange carried out by two surgeons between 03/2016 and 12/2019 (45 months). Intraocular pressure (IOP) and best-corrected visual acuity (BCVA) were analyzed preoperatively and at 5 time points up to 12 months after lens exchange. Data on postoperative complications were collected. Results There were 124 eyes with intraocular lens dislocation that were referred for lens exchange. Of these eyes, 59 (48%) received core vitrectomy and 65 (52%) received pars plana vitrectomy with lens exchange. Glaucoma was more frequent in the core vitrectomy group (78%) than in the pars plana vitrectomy group (32%; p < 0.001). In the core vitrectomy group, 19 (32%) eyes presented with visual impairment, 17 (29%) eyes presented with high IOP alone, and 23 (39%) eyes presented with both at the same time prior to surgery. Mean preoperative IOP in the core vitrectomy group decreased from 22.4 ± 9.2 mmHg to 14.7 ± 3.1 mmHg 12 months after surgery (p < 0.001). Mean BCVA changed from 0.40 ± 0.41 logMAR preoperatively to 0.32 ± 0.37 logMAR at 12 months postoperatively (p = 0.598) in the core vitrectomy group. In the pars plana vitrectomy group, 44 (68%) eyes presented with a change in vision, 7 (11%) eyes presented with high IOP alone, and 14 (22%) eyes presented with pressure elevation and visual impairment at the visit prior to surgery. Mean preoperative IOP in the pars plana vitrectomy group decreased from 20.9 ± 8.3 mmHg to 15.1 ± 3.5 mmHg at 12 months after lens exchange (p < 0.001). Mean BCVA in the pars plana vitrectomy group was 0.57 ± 0.62 logMAR preoperatively and 0.22 ± 0.35 logMAR 12 months postoperatively (p < 0.001). Postoperative pressure decompensation occurred more frequently in the core vitrectomy group (20%) than in the pars plana vitrectomy group (6%; p = 0.018). There was no statistically significant difference for postoperative cystoid macular edema (p = 0.055), anisometropia (p = 0.986), and high astigmatism (p = 0.362). Conclusion Core vitrectomy and pars plana vitrectomy with lens exchange are equally efficient and safe in the management of intraocular lens dislocation.