Late in-the-bag intraocular lens dislocation: Incidence, prevention, and management

Abstract

Dislocation of an intraocular lens (IOL) with the capsular bag is a late complication of cataract surgery, reported with increasing frequency in recent years. Pseudoexfoliation, uveitis, myopia, and other diseases associated with progressive zonular weakening and capsular contraction are the predisposing conditions. Capsular tension rings probably help but do not prevent this complication. Management includes IOL exchange, replacement with an anterior or a sutured posterior chamber IOL, or suturing the IOL through the bag to the iris or the sclera.

Comparision of surgical outcomes of intraocular lens refixation and intraocular lens exchange with perfluorocarbon liquid and fibrin glue-assisted sutureless scleral fixation

“…The IOL is extracted from the capsular bag with a vitreous cutter or serrated 25-gauge forceps, but this is not technically easy and in some cases may not be possible. 7 The IOL optic haptic junction should be carefully managed without damage and dissected capsules completely removed from the vitreous cavity. If the cortex adherent to the capsule is not easily removed with the vitreous cutter, the cortex can be removed by fluid reflux effect in front from the outside, through a corneal incision site.…”

“…Nd : YAG capsulotomy can be a trigger factor by weakening the zonules, in addition to their effect on the capsule. 7 Nd : YAG capsulotomy was performed on all five eyes in other hospitals, and hence it was not possible to investigate the period up to IOL dislocation. However, Nd : YAG capsulotomy was found to be a factor that may affect IOL dislocation.…”

“…5 In-the-bag IOL dislocation, however, usually occurs several years after cataract surgery and is thus thought to depend on slowly progressive dehiscence of the zonules. 6,7 When endocapsular IOL placement is not possible, the choices include sutured scleral-fixated IOLs, 8,9 sutureless scleral-fixated IOLs, 10,11 iris-fixated IOLs, 12 iris-claw IOLs, 13 or anterior chamber (AC) IOLs. 14 However, scleral-fixated IOLs are subject to problems such as suture degradation, pseudophacodonesis, endophthalmitis, and late IOL decentration owing to suture-related complications.…”

Visual outcomes in patients with zonular dialysis following cataract surgery

“…4 Similarly, the CTR induces centripetal pressure, reducing capsular folds, preventing forward movement of the posterior capsule, and thereby countering progressive contractile capsular forces post-operatively. 4,7 In contrast, compression is often required to implant the CTR, which itself may introduce further zonular damage. 4,8 Furthermore, CTR may prevent full cortical aspiration by trapping the cortex within the capsular fornix.…”

Late in-the-bag intraocular lens dislocation requiring explantation: risk factors and outcomes

“…The risks factors for this condition include pseudoexfoliation (PEX), connective tissue disorders, uveitis, retinitis pigmentosa, high myopia, and patients who underwent vitreoretinal surgery. [4][5][6] Bag dislocation in these situations usually occurs a long time after cataract surgery, with a mean interval of 6.9-8.5 years. [5][6][7][8] Surgical management of this condition is usually complex and may be associated to new complications.…”