Pathological Evidence of Pseudoexfoliation in Cases of in-the-Bag IOL Subluxation/Dislocation
Narrative Responses:
Purpose
To provide complete histopathologic evaluation of explanted intraocular lens (IOL)-capsular bag complexes that spontaneously subluxated in the retropupillary space/anterior vitreous or dislocated into the vitreous following cataract surgery.
Methods
Capsular bags containing an IOL or an IOL and capsular tension ring (CTR) from 28 consecutive explanted specimens were submitted to the John A. Moran Eye Center, University of Utah by the explanting surgeons in Frankfurt, Germany. Specimens were examined macroscopically and microscopically for IOL design, material composition, and notable pathology. Histopathologic analysis was completed on each specimen with particular focus paid to the presence or absence of an amorphous substance on the outer surface of the anterior capsule in an “iron-filing” pattern, suggestive of PEX material. Additionally, the explanting surgeons submitted a clinical course summary with each specimen.
Results
One specimen was subluxated; the remaining dislocated. Different IOL materials/designs were represented (3 single-piece hydrophobic acrylic, 10 3-piece hydrophobic acrylic, 5 3-piece silicone, 3 single-piece PMMA, 5 single-piece hydrophilic acrylic, and 2 3-piece hydrophilic acrylic lenses). Two specimens contained a CTR. Subluxation/dislocation occurred late postoperatively in all cases (minimum of 4 years). A history of PEX was noted in 11 cases. However, pseudoexfoliative material was found in 18 cases. Out of 10 cases without pathologic evidence of PEX, associated ocular conditions were retinitis pigmentosa (1), previous vitrectomy surgery (2), Marfan’s syndrome (1), and trauma (2).
Conclusion
PEX may be implicated in a larger proportion of late in-the-bag IOL subluxation/dislocation than previously thought due to significant clinical under-diagnosis, which was demonstrated here upon histopathologic examination. This may impart a need for new considerations during the pre and post-operative cataract surgery assessments and follow-up.