In-the-Bag IOL Dislocation: Comparison of Presentation Characteristics and Surgical Outcomes in Eyes With and Without CTR
Narrative Responses:
Purpose
To evaluate the presentation characteristics and surgical outomes of late in the bag IOL dislocation and to compare cases with and without capsular tension ring (CTR) within the capsular bag.
Methods
Retrospective (2005-2009)/prospective (2010-2013) interventional case series including cases of late spontaneous in-the-bag IOL dislocation from two referral centers. The main outcome measures were interval between surgery and dislocation, dislocation site/grade, type of IOL, associated CTR, predisposing factors, surgical technique used to correct dislocation (repositioning using scleral fixation (SFIOL), iris suturing, IOL exchange for anterior chamber IOL (ACIOL), or iris–claw IOL (ICIOL), IOL removal and anterior capsulotomy), preoperative/postoperative corrected distance visual acuity (CDVA), and surgical complications.
Results
105 cases of in-the-bag IOL dislocation were identified. Most common risk factor:Pseudoexfoliation. CTR the capsular bag: 21 cases. Dislocation was corrected in 101 cases: 1) repositioning using SFIOL (48 cases), iris suturing (1 case); 2) IOL exchange ACIOL (29 cases) or ICIOL (20 cases); 3) IOL removal (1 case); 4) capsulotomy (2 cases). Mean CDVA improved significantly after surgery (p=0.0001). There was no significant difference in postoperative CDVA between SFIOL, ACIOL and ICIOL (p=0.753) or between the group with or without CTR. IOL repositioning was performed in 50% of cases with CTR vs 46.9% of cases without CTR.
Conclusion
Pseudoexfoliation was the main risk factor for in-the-bag IOL dislocation. A CTR within the bag did not prevent dislocation but facilitated IOL repositioning. Satisfactory results were achieved with a low rate of complications using different surgical alternatives to correct IOL position.