Pathologic Evidence of Pseudoexfoliation in Cases of IOL Subluxation/Dislocation Within Capsular Bag

Sunday, April 19, 2015: 2:21 PM
Room 5A (San Diego Convention Center)
Nick Mamalis, MD
Liliana Werner, MD, PhD
Erica T. Liu, MD
Scott C. Cole, MD
Fritz Hengerer, MD
Thomas Kohnen, MD, PhD

To provide complete histopathologic evaluation of explanted capsular bags with intraocular lenses that spontaneously dislocated in the late postoperative period to assess for the presence of pseudoexfoliation.

Fifty-three explanted capsular bags containing an intraocular lens (IOL) or a caspular tension ring (CTR) and an IOL which were subluxated/dislocated underwent gross and histopathologic microscopic evaluation. Questionnaires were sent to explanting surgeons and patient charts were reviewed when available regarding the presence of pseudoexfoliation.

The specimens consisted of capsular bags containing an IOL (50) or an IOL with CTR (3).  The IOLs included three-piece hydrophobic acrylic (16), one-piece hydrophobic acrylic (9), three-piece silicone (7), one-piece hydrophilic acrylic (7), three-piece hydrophilic acrylic (3), and one-piece PMMA (11) designs.  All CTRs were made of PMMA. Eleven specimens exhibited mild Soemmering’s ring (SR) formation, 20 showed moderate SR, and 22 exhibited severe SR.  Excessive contraction of the capsular bag with capsular phimosis was observed in 28 specimens.  Thirty-three specimens had histopathologic evidence of PXF while only 16 had a clinical history of PXF.

PXF may be implicated in a larger proportion of late capsular bag subluxation/dislocation with an IOL than previously thought.  There was a significant under diagnosis of PXF clinically prior to cataract surgery.