Elsevier

Ophthalmology

Volume 116, Issue 4, April 2009, Pages 664-670
Ophthalmology

Original article
Late In-the-Bag Spontaneous Intraocular Lens Dislocation: Evaluation of 86 Consecutive Cases

Presented in part as a poster at: American Academy of Ophthalmology Annual Meeting, November 2006, Las Vegas, Nevada.
https://doi.org/10.1016/j.ophtha.2008.11.018Get rights and content

Objective

As techniques for cataract surgery have evolved, spontaneous intraocular lens (IOL) dislocation has decreased overall. However, since 2006 the Intermountain Ocular Research Center has received an increased number of explanted IOLs within the capsular bag forwarded for pathologic evaluation. Late, spontaneous dislocation of IOLs results from zonular insufficiency and zonulysis that has been associated with pseudoexfoliation, trauma, and other risk factors. The findings of 86 consecutive cases of this complication, analyzed in the laboratory, are described.

Design

Retrospective case series.

Participants

Eighty-six IOLs explanted within the capsular bag, submitted in formalin.

Methods

Standard light microscopy of specimens, as well as questionnaire sent to explanting surgeons and patient chart review, when available.

Main Outcome Measures

Lens design, material, and abnormalities; capsular bag anomalies; patient demographic data; surgical dates; and presence or absence of known risk factors.

Results

This series included polymethyl methacrylate, silicone, and hydrophobic acrylic lenses, manufactured with both 1-piece and 3-piece designs. The mean time from surgery to spontaneous IOL dislocation was 8.5 years. The main conditions associated with the cases of IOL dislocation were as follows: pseudoexfoliation, 50%; prior vitreoretinal surgery, 19%; history of trauma, 6%; uveitis, 2%; and none or unknown, 23%.

Conclusions

Patients with any type of IOL are at risk for late in-the-bag dislocation. Pseudoexfoliation and vitreoretinal surgery were the most common associated conditions in this series. Regardless of the presence of known risk factors, IOLs dislocated on average 8.5 years after phacoemulsification and IOL implantation.

Financial Disclosure(s)

The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Section snippets

Materials and Methods

This retrospective study was designed to analyze posterior chamber IOLs spontaneously dislocated within the capsular bag after cataract surgery. All explanted IOLs within the capsular bag that were forwarded to the Intermountain Ocular Research Center at the John A. Moran Eye Center, University of Utah, for pathologic evaluation from March 2000 through March 2008 were included in the study. They were submitted to the laboratory immersed in fixative, such as 10% neutral buffered formalin. The

Results

Surgeons submitted 86 IOLs that were dislocated within the capsular bag to the Pathology Laboratory of the Intermountain Ocular Research Center over this 8-year period. Fifty-nine of the total 86 IOLs were submitted from January 2006 through March 2008. Complete patient history information could not be obtained for every IOL specimen. Information on the visual outcome of each case generally could not be collected by the time the specimens were submitted. Table 1 shows the materials and designs

Discussion

Decentration and dislocation of IOLs are serious optical malpositioning complications of cataract surgery. Reports during the 1980s showed that IOLs dislocated with a cumulative incidence from 0.2% to 3% when placed within the capsular bag. More recent data are difficult to assess. Intraocular lenses seem to dislocate in a bimodal distribution with respect to time. These dislocations, referred to as early and late, generally are initiated by 2 causes: improper fixation within the capsular bag

References (25)

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Manuscript no. 2008-985.

Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Supported in part by an unrestricted grant from Research to Prevent Blindness, Inc., New York, New York, to the Department of Ophthalmology & Visual Sciences, University of Utah, Salt Lake City, Utah.

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