A classification system of intraocular lens dislocation sites under operating microscopy, and the surgical techniques and outcomes of exchange surgery

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.

The wandering intraocular lens: an unusual suspect

“…Furthermore, one‐piece type IOLs are generally not anatomically suitable for sulcus placement and would be expected to have caused symptoms earlier, if the one‐piece IOL was initially placed in the sulcus. Due to intermittent prolapse of one of the IOL haptics through the pupil, the dislocated IOL appeared to be ‘out‐of‐the‐bag’ (that is, IOL not enclosed by lens capsule), which is most commonly associated with capsular complications at time of cataract surgery, eye rubbing/tapping and secondary IOL implantation …”

“…It is possible that only one haptic was inadvertently placed in the sulcus with the remainder of the IOL placed in the bag. Risk factors for ‘in‐the‐bag’ IOL dislocations (that is, IOL within lens capsule dislocating as a whole complex from zonular compromise) include pseudoexfoliation, eye rubbing/tapping, long axial length and post‐vitrectomy . A case of ‘in‐the‐bag’ IOL dislocation four years post‐vitrectomy repair of a retinal detachment after trauma which occurred five months after phacoemulsification and posterior chamber IOL insertion, has been described in a myopic eye with traumatic mydriasis .…”

Broken intraocular lens haptic during cataract surgery

“…In all papers that we found in the literature, the surgeon removed the IOL when one haptic was broken. In cases where the IOL has to be removed, the surgeon has to either fold [2] the IOL or chop [3] it in half and remove the two separate pieces with forceps. The purpose of this case report is to mention the fact that the IOL can remain well centred inside the capsular bag, even in cases where the one haptic is missing.…”

Features of Surgical Correction of Spontaneous Luxation of the Complex “IOL Posterior Chamber – Capsular Bag”

“…Кроме того, к факторам риска развития данного состояния относятся большие аксиальные размеры глазного яблока при миопии, перенесённый увеит, травмы, предшествующая витреоретинальная хирургия. Некоторые авторы к факторам риска относят наличие искусственного хрусталика в глазу более 10 лет вне зависимости от возраста пациентов [1,2,3]. В наших предыдущих публикациях было показано, что модель ИОЛ, имплантированная в ходе хирургического лечения катаракты, не является фактором риска, определяющим возможность её люксации [4].…”

“…В наших предыдущих публикациях было показано, что модель ИОЛ, имплантированная в ходе хирургического лечения катаракты, не является фактором риска, определяющим возможность её люксации [4]. Целый ряд исследований показал, что число поздних спонтанных дислокаций заднекамерных ИОЛ варьирует от 0,1 % в США до 1,0 % в Швеции и Норвегии [3].…”