Trans-iris fixation of dislocated in-the-bag intraocular lenses

Abstract

Purpose: The aim of this article is to describe the safety and efficacy of trans-iris suture fixation for the management of late dislocation of in-the-capsular-bag intraocular lenses following uncomplicated cataract surgery. Patients and methods: Eleven eyes of 11 patients with late in-the-capsular-bag intraocular lens dislocation following uneventful phacoemulsification cataract surgery were recruited in the study. The dislocated intraocular lens–capsular bag complex was sutured to the iris at two points 180° apart using 9-0 polypropylene sutures on long needles. Results: Mean patient age was 67 ± 6 years. Seven eyes had pseudoexfoliation syndrome, one eye had Marfan syndrome, and another eye had a traumatic cataract; no risk factor was identified for intraocular lens dislocation in two eyes. A capsular tension ring had been implanted during cataract surgery in four eyes. In six eyes, the posterior chamber intraocular lenses were one-piece foldable while the remaining were three-piece intraocular lenses. Compared to the preoperative value, corrected distance visual acuity was significantly improved postoperatively ( p < 0.005). Intraoperative hyphema occurred in two eyes. Pupil ovalization was observed in all eyes. Mean endothelial cell count decreased by 4 ± 1.7% after intraocular lens fixation. The capsular bag–intraocular lens complex was stable and well-centered in the pupillary area in all eyes at the final follow-up examination which was performed 16 ± 4 months postoperatively. Conclusion: Trans-iris fixation is a simple and effective procedure for management of late intraocular lenses–capsular bag complex dislocation, without major complications.

Late in-the-bag intraocular lens dislocation

“…Most studies in this review were observational and retrospective, and many of them included fewer than 50 patients with late in-the-bag IOL dislocation. 13–15,29,41,45–47,49,50,56,58,59,62 The articles varied in terms of whether they reported specific inclusion criteria in detail, and even if so, most articles did not indicate whether the criteria were defined before or after the data were gathered, or who performed the review of the medical records. In a few studies, some of the results were based on reporting forms filled out by the surgeons; a few others used standardized forms for obtaining information from medical records.…”

“…Of the included articles, 29 had only late in-the-bag IOL dislocation patients, with 1 randomized clinical trial, 1 prospective case series, 1 cohort study, and 4 histopathologic studies of dislocated in-the-bag IOL complexes either in general or with capsular tension ring (CTR) specifically; the remaining were retrospective clinical studies. 13,14,16,18,20,21,[23][24][25]27,29,[32][33][34][35][36][37][40][41][42][43][44][45][46][47][48][49][50][51][52][53] In another 11 articles, at least 50% of the patients had late in-the-bag IOL dislocation, of which 1 was a prospective cohort study and the remaining were retrospective studies. 15,26,[54][55][56][57][58][59][60][61][62] Further 2 articles mentioned in-the-bag IOL dislocation as part of a population study.…”

“…Late in-the-bag IOL dislocation occurs on average 6 to 12 years after cataract surgery, and the mean patient age varies between 65 and 85 years. [13][14][15][16]20,21,[23][24][25][26][27]29,[40][41][42][44][45][46][47][48][49]54,55 Some studies report a predominance of men, with proposed explanations suggesting that they have weaker zonular fibers and/or more frequently experience trauma. 13,15,22,23,29,41,47,80 Other studies have shown no difference or have found a small predominance of women, suggesting that this reflects their likely higher prevalence of PEX and/or the sex difference for pseudophakia (with more women having cataract surgery), in addition to their higher life expectancy.…”

“…PEX has been established as 1 of the most important predisposing factors (Table 1), being present in 31% to 83% of cases (except a few studies showing proportions of 16% to 17%). 13,15,16,20,[22][23][24][25]40,41,[46][47][48] Furthermore, some studies have only included patients with PEX. 14,21,25,55 Varying proportions of PEX may be related to differences in study inclusion criteria, patient ages, or geographical variation.…”