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

Abstract

Aim:An analysis of late in-the-bag dislocation of intraocular lenses (IOL), in uveitic eyes.Setting:Referral uveitis clinic.Design:Retrospective case series.Materials and Methods:All case records of eyes with chronic uveitis that had phacoemulsification with IOL implantation, at a referral uveitis clinic between February 1997 and January 2015 were retrieved and analyzed. Only those eyes with no documented intraoperative complication and no predisposing risks to IOL dislocation, such as pseudoexfoliation, high myopia, trauma, and prior VR surgery were included in this study.Results:A total of 581 eyes with chronic uveitis underwent phacoemulsification with IOL implantation under steroid cover from February 1997 to December 2015. Out of these 581 eyes, 10 patients (11 eyes) had experienced late in-the-bag IOL dislocation (1.89%). All 11 eyes had chronic intermediate uveitis. The mean duration from the time of cataract surgery to IOL dislocation was 11.24 years. 5 out of 11 eyes had pars plana vitrectomy (PPV) with IOL removal with 4-point sutured scleral fixated IOL. Two out of 11 eyes had PPV with in-the-bag IOL re-fixation. Out of 11, 2 eyes had PPV with IOL removal only. Remaining 2 eyes of 2 patients did not opt for surgery. Out of 11, 8 eyes had improved vision at last follow-up.Conclusions:In-the-bag dislocation of IOL is a rare late complication in uveitic eyes. With tight perioperative inflammatory control, scleral-fixated posterior chamber intraocular lens or IOL re-fixation are good options of restoring vision in these high-risk eyes.

Surgical management of intraocular lens dislocation: A meta-analysis

“…Pooled analysis showed that the two procedures had a similar effect on BCVA (MD -0.00, 95%CI: -0.08 to 0.08, P = 0.99; Fig 2A ). We obtained similar results after excluding one small study [10] ( Fig 2B ). Pooled analysis of the two studies reporting the change in BCVA as a result of surgery showed the two procedures to be similar (MD 0.09, 95%CI -0.08 to 0.26, P = 0.32; Fig 2C ).…”

“…This alters the position of the IOL-bag complex, ultimately dislocating it [12,32,33]. Other risk factors for IOL dislocation included trauma [7,9,11,14,18,21], high myopia [11,14,24], previous intraocular surgery [14,18–20], capsulotomy or capsular rupture [7,11,18–20,23], uveitis [9,10,14], Marfan’s syndrome [24], retinitis pigmentosa [5].…”

Late Dislocation of In-the-Bag Intraocular Lens in Three Patients with Multiple Chorioretinal Atrophy Associated with Sarcoidosis

“…In relatively large studies, 6 of 1056 patients with uveitis (0.57%) 4 and 11 of 581 patients (1.89%) 5 that underwent cataract surgery were reported to have a late dislocation of the IOL. Fuchs’ heterochronic uveitis, multifocal choroiditis, birdshot retinochoroiditis, chronic intermediate, chronic idiopathic pan uveitis, and sympathetic ophthalmitis were diagnosed in 6 of the 1056 patients who had an IOL dislocation.…”

“… 1 , 2 In uveitis patients who had undergone cataract surgery, a late in-the-bag IOL dislocation was found in only 6 of 1056 (0.57%) eyes in one study 4 and 10 of 581 (1.89%) eyes in another study. 5 The majority of these eyes had intermediate uveitis. 4 , 5 …”

Uveitis and deficient lens capsules: Effect of glued intraocular lens on the visual outcome and the reactivation of inflammation

“…[27] Late dislocation of capsular bag IOL has been reported in uveitic eyes. [2829] Since uveitic eyes are more prone for zonular dehiscence on long term, there can be decenteration or tilt induced by zonular weakness. Transscleral fixated IOL has shown better outcomes compared to sutured scleral fixated IOL as studied by Sinha et al [30] Todorich et al reported 5 eyes with uveitis showing good visual outcomes after intrascleral IOL fixation.…”