Incidence of cystoid macular edema with iris-fixated posterior chamber intraocular lenses in patients presenting with lens dislocation

Abstract

The aim of this study is to determine the incidence of cystoid macular edema (CME) following repositioning and McCannel iris-suturing of dislocated intraocular lenses. This study is conducted in an urban private practice. A retrospective chart review was performed on consecutive patients who presented with posteriorly dislocated IOLs and underwent iris-sutured posterior chamber (PC) intraocular lens (IOL) placement using the McCannel suture technique by a single surgeon for IOL repositioning from December 2008 to August 2012. All charts were reviewed for etiology of dislocation, time elapsed from cataract surgery, best-corrected visual acuity (BCVA), slit-lamp examination, tonometry, and dilated fundus examination. Presence of CME was determined by spectral domain optical coherence tomography (Cirrus HD OCT; Carl Zeiss Meditec, Dublin, California, USA). Of the 58 cases reviewed, lens dislocation resulted from trauma in 21 %, zonular incompetence in 17 %, recent intraocular surgery in 12 %, and unknown in 50 %. Mean best-corrected logMAR visual acuity improved from 1.07 preoperatively to 0.52 postoperatively (P < 0.001). The mean follow-up time was 7.8 months. Two cases (3.4 %) of CME occurred postoperatively at a mean follow-up time of 4.5 months. Of these two patients, one had concurrent fragmetome lensectomy at the time of initial surgery. Iris-sutured PC IOL placement in this case series resulted in an improvement in BCVA with a low incidence of CME.

Surgical outcomes of intraocular lens iris suture fixation in eyes with residual capsule support

“…All eyes with CME were managed with topical administration of steroidal and nonsteroidal anti-inflammatory medications. Our results regarding incidence of CME are similar to those reported by Rusu et al, McClellan et al, and Faria et al 11,14,15 However, CME was reported as high as 28% in a series of combined PKP with ISF of the secondary IOL; it is unclear if the combined nature of the surgery in that report was responsible for the significantly greater incidence of CME. 16 However, in a more recent retrospective investigation from Baylor University, the early postoperative incidence of CME was reported at 10% and a 13% late CME incidence was noted.…”

“…In general, ISF has a safety track record that is widely considered to be acceptable. [8][9][10][11] However, our previous (unreported) clinical experience with 5 cases of ISF in eyes with no capsule remnant suggests that there is a higher likelihood for chronic inflammation, CME, IOL tilt, and decentration if the method is used in eyes that have had pars plana vitrectomy or extensive loss of the capsule bag remnant. In those cases, extensive irido-pseudophakodonesis may be evident and perhaps responsible for postoperative IOL dislocation and chronic inflammation.…”

Single haptic iris fixation of posterior chamber intraocular lens

“…Reports from previous studies have shown an incidence of CME in iris-fixated PCIOL of 0–3.4%. [ 10 , 11 ] However, this technique is not suitable for pigmented neovascular or advanced glaucoma, serious iris trauma, iridodialysis or atrophy of the iris,[ 12 ] progressive zonular weakness like pseudoexfoliation and retinitis pigmentosa, and chronic uveitis and complicated cataract. The limitation of the study is its short follow-up period; also, IOL position assessment using ultrasound biomicroscopy/anterior segment optical coherence tomography was not done.…”

Complications of pupil expansion devices: a large real-world study

“…The etiological factors leading to an increased rate of uveitis and PCME in eyes with pupil expansion devices may be related to inflammatory mediators generated in the anterior segment, which travel through the vitreous, enter the posterior segment and disrupt the blood-retinal barrier in the macular region, causing intraretinal fluid to accumulate (8). As the iris is a metabolically active tissue, proinflammatory cytokines (interleukin-6, prostaglandin E2, and tumor necrosis factor-alpha) are released following surgical injury, trauma, or ischemia (9)(10)(11)(12)(13)(14). These cytokines ultimately result in a cascade of inflammation with clinical manifestations of uveitis or PCME (15,16).…”