In-bag dislocation of intraocular lens in patients with uveitis: a case series

Abstract

BackgroundImprovement in surgical devices and intraocular lenses has made modern cataract surgery a safe procedure with decreasing complication rates. Intraocular lens dislocation is a serious complication after cataract surgery. Although most dislocations occur during the first week postoperative period, late intraocular lens dislocation occurring 3 months or later post-surgery has been reported with increasing frequency in recent years as a result of progressive zonular dehiscence. We report the clinical features, management and outcomes of five cases of late in-bag dislocation of intraocular lens in patients with underlying uveitis. This is a retrospective case series and literature review.ResultsWe identified five eyes in five patients with uveitis and late in-bag intraocular lens dislocation. Two patients had multifocal choroiditis, two herpetic uveitis and retinitis and two Fuchs’ heterochromic iridocyclitis in five patients. Mean age at the time of cataract surgery was 50. Best vision ranged from counting fingers to 6/18 preoperatively and ranged from 6/36 to 6/6 postoperatively. All had right eye dislocation with mean time from initial cataract surgery to intraocular lens dislocation of 81 months. Explantation of dislocated intraocular lens and vitrectomy were performed in four cases; three had anterior chamber intraocular lens placement. One case was managed conservatively. Best vision ranged from light perception to 6/7.5 at time of dislocation and ranged from 6/36 to 6/6−2 at follow-up.ConclusionsLate in-bag dislocation intraocular lens can complicate cataract surgery in patients with underlying uveitis. This case series identified that the mean time to in-bag intraocular lens dislocation in five uveitis patients was 81 months after uncomplicated cataract surgery, comparable with the time reported in the available literature of patients with pseudoexfoliation syndrome. This series also found that lens explantation and replacement with anterior chamber intraocular lens achieved good outcomes. Further investigation is warranted to ascertain the strategies to identify patients at risk and to prevent and better manage intraocular lens dislocation in patients with uveitis.

Late dislocation of in-the-bag intraocular lenses in uveitic eyes: An analysis of management and complications

“…Several predisposing conditions identified in literature include trauma, pseudoexfoliation, vitrectomy, increased axial length and uveitis. [91012141522] IOL dislocation is an uncommon late complication in patients with uveitis. In-the-bag-IOL dislocation in uveitis has been recently reported in literature.…”

“…In-the-bag-IOL dislocation in uveitis has been recently reported in literature. [101415] Conservative management may be appropriate in patients with tolerable symptoms, or in those with recalcitrant uveitis. Alternatively, fixation of the existing IOL, or removal and implantation of a secondary IOL, may be necessary in others.…”

“…Two recent case series of in-the-bag IOL dislocation in uveitic eyes had shown a mean duration between 6.75 years and 10.3 years, from the cataract surgery and the IOL dislocation. [1415]…”

“…Tao and Hall in their study state that the frequent use of topical and intravitreal steroids could weaken the zonules in these high-risk eyes. [14] It is possible that in uveitic eyes, many factors such as type of uveitis (IU), recurrent inflammation, and inadequate control of inflammation, capsular bag contraction and chronic use of corticosteroids could weaken the zonules and play a major role in contributing toward late in-the-bag IOL dislocation.…”

“…However, there are few articles in the literature reporting late in-the-bag dislocation of IOLs in uveitic eyes. [91012131415]…”