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

Kristianslund, Olav; Råen, Marianne; Østern, Atle Einar; Drolsum, Liv

doi:10.1016/j.ajo.2017.01.026

Cited by 31 publications

(61 citation statements)

References 22 publications

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“…Several examinations were related to glaucoma and IOP measurements, which is consistent with the finding that 60% of the study patients had glaucoma or suspected glaucoma, in most cases related to pseudoexfoliation syndrome (Kristianslund et al. 2017a). Intraocular lens exchange had a borderline significantly more pronounced IOP decrease after surgery compared to IOL repositioning.…”

Section: Discussionsupporting

confidence: 90%

“…Previously published results from this randomized clinical trial showed that IOL repositioning by scleral suturing and IOL exchange with a retropupillary iris‐claw IOL were equally efficient and safe in terms of postoperative CDVA and serious complications after 6 months follow‐up, whereas the two operation methods differed regarding refractive predictability and postoperative IOP change (Kristianslund et al. ,b,c). Also, a few retrospective studies have indicated that IOL repositioning and IOL exchange provide equal visual outcome (Lorente et al.…”

Section: Discussionmentioning

confidence: 94%

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Cost‐effectiveness analysis in a randomized trial of late in‐the‐bag intraocular lens dislocation surgery: repositioning versus exchange

Kristianslund

Dalby

Moe

et al. 2019

Acta Ophthalmologica

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Purpose: To compare the cost-effectiveness of two operation methods for late inthe-bag intraocular lens (IOL) dislocation. Methods: In this randomized clinical trial, 104 patients were randomly assigned to IOL repositioning by scleral suturing (n = 54) or IOL exchange with a retropupillary iris-claw lens (n = 50). A cost-effectiveness analysis (CEA) was performed in conjunction with previously published 6-month efficacy and safety results. An incremental cost-effectiveness ratio was calculated as the cost difference between the operation groups relative to their difference in postoperative corrected distance visual acuity (CDVA) (mean and 95% confidence interval: minimum and maximum), reported as the cost difference in United States Dollars ($) per logMAR difference. Results: Exchange surgery was $281.20 AE 17.66 more expensive than repositioning, mainly explained by the new IOL and the frequent use of anterior vitrectomy. A previous trial publication revealed no significant difference in the 6-month postoperative CDVA between the groups. In the CEA, the mean group difference yielded an incremental cost-effectiveness ratio of À$281.20 per À0.11 logMAR (-$1108/QALY) in favour of repositioning, ranging from À$281.20 per À0.29 logMAR (-$406/QALY) in favour of repositioning to +$281.20 per À0.08 logMAR (+$1522/QALY) in favour of exchange. The CEA did not include the mean 9.5 min shorter operation time for exchange. Conclusion: Repositioning tended to be more cost-effective than exchange; however, this is modified if also considering the operation time. Overall, it seems the cost-effectiveness is not alone sufficiently different to recommend one of the operation methods over the other for late in-the-bag IOL dislocation.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 94%

Cost‐effectiveness analysis in a randomized trial of late in‐the‐bag intraocular lens dislocation surgery: repositioning versus exchange

Kristianslund

Dalby

Moe

et al. 2019

Acta Ophthalmologica

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“…Exchange surgery should therefore be strongly considered in cases requiring a specific postoperative refraction, or in cases where a myopic shift should be avoided (e.g., due to risk of inducing unacceptable anisometropia). However, other differences between the operation methods 1,39 must also be taken into account in the choice of operation method in clinical practice.…”

Section: Discussionmentioning

confidence: 99%

Astigmatism and Refractive Outcome After Late In-The-Bag Intraocular Lens Dislocation Surgery: A Randomized Clinical Trial

Kristianslund

Østern

Drolsum

2017

Invest. Ophthalmol. Vis. Sci.

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PURPOSE.To compare surgically induced astigmatism (SIA) and refractive outcomes between two operation methods for late in-the-bag IOL dislocation.METHODS. In this prospective, randomized, parallel-group clinical trial, 104 patients (eyes) were assigned to IOL repositioning by scleral suturing 1.5-to 2-mm posterior to limbus (n ¼ 54) or IOL exchange with a retropupillar iris-claw IOL using a 5.5-mm scleral pocket incision (n ¼ 50). The SIA was determined by vector analysis through conversion of corneal cylinders to Cartesian coordinates, and is presented as magnitude in diopters @ direction in degrees (D @ 8). Follow-up was 6 months.RESULTS. The SIA was 0.24 D @ 88 for IOL repositioning and 0.65 D @ 1718 for IOL exchange, which was a nonsignificant group difference (X coordinate: P ¼ 0.08; Y coordinate: P ¼ 0.16). Mean SIA magnitude was 0.60 6 0.50 D and 1.12 6 0.85 D, respectively (P < 0.001). Mean postoperative spherical equivalent was À1.6 6 1.6 D after IOL repositioning and À0.5 6 1.0 D after IOL exchange (P < 0.001). For IOL repositioning, this represented a mean myopic shift of À0.7 6 1.1 D compared with before the IOL dislocation (P < 0.001). For IOL exchange, it was within 61 D of target refraction in 83% of the patients.CONCLUSIONS. Surgically induced astigmatism was modest in both operation groups, albeit with a tendency of being more pronounced for IOL exchange. Repositioning surgery led to a myopic shift, whereas exchange surgery provided good refractive predictability.

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“…The average age of patients was 73.6±10.1yr, and average duration of follow-up was 13.7 months. Quality assessment of the RCT indicated a low risk of bias [14,16,17]. Three studies received a score≥15 [7,15,21]; 8 studies, a score of 10–15 [9–11,18–20,22,24]; and 2 study, a score <10 [23,25].…”

Section: Resultsmentioning

confidence: 99%

Surgical management of intraocular lens dislocation: A meta-analysis

et al. 2019

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Purpose To compare the efficacy and safety of intraocular lens (IOL) repositioning and IOL exchange for the treatment of patients with IOL dislocation. Methods We systematically searched for relevant publications in English or Chinese in MEDLINE, Embase, the Cochrane Central Register of Controlled Trials, WHO International Clinical Trial Registration Platform, Clinical Trial.gov, China Biology Medicine Database, China National Knowledge Infrastructure Database and grey literature sources. Study quality was assessed using the STROBE template for observational studies and the Cochrane template for randomized controlled trials (RCTs). Data were meta-analyzed using RevMan 5.3. Results The review included 14 English-language studies reporting 1 RCT and 13 retrospective case series involving 1,082 eyes. Average follow-up time was 13.7 months. Pooled analysis of 10 studies showed that the two procedures had a similarly effect on best corrected visual acuity (MD -0.00, 95%CI: -0.08 to 0.08, P = 0.99). Pooled analysis of nine studies showed no significant difference in incidence of IOL redislocation (RR 2.12, 95%CI 0.85 to 5.30, P = 0.11); pooled analysis of seven studies showed greater extent of incidence of cystoid macular edema in IOL exchange (RR 0.47, 95%CI 0.21 to 1.30, P = 0.06). Pooled analysis of three studies showed greater extent of incidence of anterior vitrectomy in IOL exchange (RR 0.11, 95%CI 0.04 to 0.33, P<0.0001). Pooled analysis of two studies showed greater postoperative spherical equivalents in IOL repositioning (MD 1.02, 95%CI 0.51 to 1.52, P<0.0001). pooled analysis suggested no significant differences between the two procedures in terms of intraocular pressure, endothelial cell density, surgically induced astigmatism, or incidence of retinal detachment, intraocular hemorrhage or pupillary block. Conclusion IOL repositioning and exchange are safe and effective procedures for treating IOL dislocation. Neither procedure significantly affects best corrected visual acuity and IOL redislocation. IOL exchange was superior to repositioning in terms of postoperative SE, but IOL repositioning was associated with lower incidence of anterior vitrectomy, potentially lower incidence of cystoid macular edema.

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

Cited by 31 publications

References 22 publications

Cost‐effectiveness analysis in a randomized trial of late in‐the‐bag intraocular lens dislocation surgery: repositioning versus exchange

Cost‐effectiveness analysis in a randomized trial of late in‐the‐bag intraocular lens dislocation surgery: repositioning versus exchange

Astigmatism and Refractive Outcome After Late In-The-Bag Intraocular Lens Dislocation Surgery: A Randomized Clinical Trial

Surgical management of intraocular lens dislocation: A meta-analysis

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