Possible Predisposing Factors for Late Intraocular Lens Dislocation After Routine Cataract Surgery

Abstract

Objective. The aim of this study was to evaluate possible risk factors for late intraocular lens (IOL) dislocation after routine cataract surgery.Material and Methods. A retrospective analysis of medical records of all the patients who were treated in the university hospital between 2011 and 2012 for late IOL dislocation requiring surgical management after routine cataract surgery was performed. In total, 58 patients (58 eyes) were included into the study.Results. The mean time between cataract surgery and late IOL dislocation was 67.8 months (SD, 34.9). A negative correlation was found between the patient age at cataract surgery and the time between cataract surgery and IOL dislocation (r=-0.29; P=0.042). Late in-the-bag dislocation occurred in 87.9% and late out-of-the-bag dislocation in 12.1% of the cases. Pseudoexfoliation was present in 56.9% and 42.9% of the eyes with in-the-bag and out-of-the-bag dislocation, respectively. The odds ratio for IOL dislocation within 43 months after complicated cataract surgery was 24.0 (95% confidence interval P<0.001). The odds ratio for in-the-bag IOL dislocation within 43 months after advanced cataract surgery was 18.8 (95% CI, P=0.011). Moreover, in-the-bag IOL dislocation occurred earlier in the patients with past uveitis (P=0.020) or zonule laxity (P=0.037).Conclusions. Complicated cataract surgery increased the risk of both late in-the-bag and out-ofthe-bag IOL dislocation, and advanced cataract increased the risk of late in-the-bag IOL dislocation. The time to in-the-bag IOL dislocation shortens with pseudoexfoliation syndrome, advanced age, or past uveitis. These factors must be taken into account while planning a postoperative follow-up.

Late in-the-bag intraocular lens dislocation in patients with uveitis

“…A large population-based study identified a risk of 0.1% after 10 years, but 1.7% after 25 years, with pseudoexfoliation being the most common risk factor 17. Other publications1–5 8 14 15 18 have found pseudoexfoliation to be overwhelmingly the most common association (table 2), with a mean interval between cataract surgery and IOL dislocation ranging from 5.5 years to 8.5 years. By contrast, uveitis is considered a much lesser risk factor 4 15.…”

“…Clearly, IOL dislocation can be a very late complication in patients with uveitis. Kre˙psšte˙ et al 14 reported that IOL dislocation occurred earlier in patients with past uveitis (35.3 months vs 67.8 months for others). Our data, albeit in a small group of patients with no other identified risk factors for dislocation, appears to conflict with this finding, showing late dislocation in comparison with other reports.…”

“…In this context, reduced but tolerable vision may suggest conservative management. Also, in any patient with IOL dislocation and posterior capsule opacification, Nd:YAG capsulotomy should be regarded as high risk for provocation of complete IOL dislocation 5 14…”

“…Recent published series of IOL dislocations have included small numbers of uveitis cases 1–5 8 14 15. However, a previous study of cataract surgery in patients with uveitis emanating from this clinic with postoperative follow-up of greater than 7 years identified no cases of IOL dislocation 16.…”

Trans-scleral explantation of posteriorly dislocated IOL-CTR complex in a case of anterior megalophthalmos with an unusually thin cornea

“…The dislocated IOL-CTR complex can be repositioned and fixed in to the sclera or explanted and exchanged with either a scleral fixed10 or anterior chamber IOL. Repositioning of the complex can be effectively achieved with PPV and use of PFCL11 as well as by anterior approach without vitrectomy 12. This case had a unique situation where repositioning of the IOL-CTR complex by scleral fixation was not possible due to large ciliary ring diameter.…”