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Meta-Analysis
. 2019 Feb 20;14(2):e0211489.
doi: 10.1371/journal.pone.0211489. eCollection 2019.

Surgical management of intraocular lens dislocation: A meta-analysis

Shangfei Yang  1 , Kailai Nie  1 , Hui Jiang  1 , Liwen Feng  1 , Wei Fan  1
Affiliations
Meta-Analysis

Surgical management of intraocular lens dislocation: A meta-analysis

Shangfei Yang et al. PLoS One. .

Abstract

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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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Flow diagram of study selection.
Fig 2
Fig 2. Comparison of IOL repositioning and IOL exchange in terms of BCVA.
(A) Postoperative BCVA. (B) Sensitivity analysis of postoperative BCVA, after excluding a small study. (C) Difference between peri- and postoperative BCVA. (D) Incidence of BCVA>20/40. (E) Incidence of BCVA 20/50–20/200. (F) Incidence of BCVA <20/200.
Fig 3
Fig 3. Comparison of IOL repositioning and IOL exchange in terms of incidence of IOL redislocation.
Fig 4
Fig 4. Comparison of IOL repositioning and IOL exchange in terms of CME incidence.
Fig 5
Fig 5. Comparison of IOL repositioning and IOL exchange in terms of incidence of anterior vitrectomy.
Fig 6
Fig 6. Comparison of IOL repositioning and IOL exchange in terms of postoperative SE.
Fig 7
Fig 7. Comparison of IOL repositioning and IOL exchange in terms of IOP.
(A) Postoperative IOP. (B) Increase in postoperative IOP relative to perioperative IOP.
Fig 8
Fig 8. Comparison of IOL repositioning and IOL exchange in terms of incidence of retinal detachment.
Fig 9
Fig 9
Comparison of IOL repositioning and IOL exchange in terms of other complications:(A) incidence of intraocular hemorrhage; (B) incidence of pupillary block; (C) SIA; (D) postoperative ECD.
Fig 10
Fig 10. Funnel Plot of Publication Bias for IOL redislocation.
See this image and copyright information in PMC

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