Management of dislocated intraocular lenses

Abstract

Purpose: The purpose of this study was to characterize the contemporary clinical presentation and treatment results of patients with dislocated intraocular lenses (IOLs).

Design: Retrospective, noncomparative, single-surgeon interventional case series.

Participants: Two hundred eighty-four eyes of 277 patients operated for dislocated IOLs; 184 eyes with >3 months follow-up information were analyzed for visual outcomes.

Methods: Review of preoperative, intraoperative, and postoperative clinical features from patient charts.

Main outcome measures: Best-corrected visual acuity, reoperations, and complications such as retinal detachment and postoperative refraction.

Results: The study included eyes with polymethyl methacrylate IOLs (n = 113), silicone plate IOLs (n = 51), 3-piece silicone IOLs (n = 38), acrylic IOLs (n = 60), and others (n = 12). There were 51 (18%) with "in-the-bag" IOL dislocations; their proportion increased during the study period and were associated with pseudoexfoliation (P = 0.01), ocular trauma (P = 0.013), and time after implantation of IOL (P = 0.006). Recurrent dislocation (17 eyes; 6%) and decentration (11 eyes; 4%) of IOLs occurred, and resulted in further surgery in 18 (6%) eyes, but were not related to the types of IOL or surgical technique. The most common complication was cystoid macular edema (29 eyes; 10%); retinal detachment occurred after management of dislocated IOL in 11 (4%) eyes. Visual results and median postoperative refractive changes for the 184 eyes with follow-up >3 months were similar regardless of surgical techniques.

Conclusions: Currently, IOL dislocation more commonly involves foldable IOLs and in-the-bag dislocation. Existing techniques of IOL repositioning with or without scleral suture fixation or IOL exchange are effective for contemporary dislocated IOLs. Preexisting conditions and postoperative complications may limit the visual outcomes.