Surgical techniques in late in-the-bag intraocular lens subluxation: a 6 year experience

Session Details

Session Title: Cataract Surgery Complications: IOL Dislocation and Opacification

Session Date/Time: Tuesday 10/10/2017 | 14:00-16:00

Paper Time: 14:38

Venue: Room 3.6

First Author: : A.Lopes PORTUGAL

Co Author(s): :    D. Silva   C. Pedrosa   B. Feijoo   P. Pego   C. Vendrell   I. Prieto     

Abstract Details

Purpose:

Late spontaneous in-the-bag intraocular lens (IOL) subluxation is defined as occurring at least 3 months later following an uneventful cataract surgery, that occurs as a result of progressive zonular dehiscence and capsular contraction. It is a rare cataract surgery complication that has been increasing in the last years. The authors analysed predisposing factors and the surgical management of this condition in their daily practice in the last 6 years. They show in video different surgical techniques, according to each clinical case and in order to be as minimally aggressive as possible.

Setting:

Ophthalmology Department, Hospital Prof. Doutor Fernando Fonseca E.P.E., Amadora, Portugal.

Methods:

Retrospective analysis of 40 eyes (42 patients) with late in-the-bag IOL subluxation, who underwent surgery correction. Inclusion criteria: complex subluxation at ≥3 months after uncomplicated phacoemulsification and a follow-up of ≥6 months. The authors reviewed: predisposing factors (pseudoexfoliation, myopia, uveitis, retinitis pigmentosa, connective tissue disorders, vitrectomy, trauma); interval between phacoemulsification and complex dislocation; pre- and postoperative corrected distance visual acuity (CDVA); surgical techniques according to the site of bag subluxation, IOL type, clinical progression and ocular diseases (repositioning of the dislocated complex with scleral suture and complex extraction with implantation of iris-enclavated IOL – pre or retropupilar); and complications.

Results:

The mean age at the diagnosis was 77.8±6.2 years, with a mean interval between phacoemulsification and IOL dislocation of 8.7±4.9 years. The main predisposing factors were pseudoexfoliation (59.6%), trauma (24.1%) and myopia (21.8%). The surgical techniques applied were IOL/capsular bag complex extraction with implantation of iris-enclavated IOL in 96% of the eyes (61% pre and 35% retropupilar implantation) and repositioning of the dislocated IOL/capsular bag complex with scleral suture in 4%. The main postoperative complication was re-dislocation (8%). Mean CDVA improved from 0.4±0.26 before surgery to 0.6±0.18 after surgery (p<0.05).

Conclusions:

As the incidence of late in-the-bag IOL dislocation is increasing, the discussion of the surgical techniques is very important in order to select the best approach to each case. The recognition of risk factors is also essential as it contributes to a surgical management as minimally aggressive as possible. Pseudoexfoliation, trauma and high myopia were the main predisposing factors in our sample. In general the surgery management can significantly improve the CDVA with a low complication rate, but a longer follow-up is needed to a further evaluation.

Financial Disclosure:

NONE