Transcript IOL dislocation

Intraocular lens (IOL)
Dislocation
M.R. Akhlaghi MD
IOL dislocation
Incidence

Intraocular lens (IOL) dislocation has
been reported to occur in 0.2% to
1.8% of patients after cataract
surgery
IOL dislocation
Causes:
Main cause is sub optimal posterior
capsule supports during or early
post operative
IOL dislocation
Causes:
During operation:
1. Unknowingly placement
2. Misjudging haptic placement
3. Misjudging capsule support
At least 180 degree of a substantially broad rim
of post. capsule at least half of which is in the
interior quadrant is necessary for satisfactory
PC IOL support.
IOL dislocation
Causes:
Days of weeks after surgery:

Spontaneously IOL haptic rotation

Zonolar dehiscent
IOL dislocation
Causes:
Months or years after surgery
 Trauma
 Spontaneously loss of zonolar
support. (PEX), Marfan syn.
IOL dislocation
Evaluation:
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Degree of lens malposition
Accompanying complications
Symptoms
IOL dislocation
Evaluation:
Degree of lens malposition
 Mild: the optic covering more than ½
pupilary space
 Moderate: the optic covering less
than ½ pupillary space
 Subluxated: open pupillary space but
in the anterior vitreous
 Luxated: completely dislocation
IOL dislocation
Evaluation:
Symptom & signs is related to degree of
malposition:
1.
Glare : related to edge of the IOL optic
2.
Induced astigmatism
3.
Decreased VA
4.
Monocular Diplopia
5.
Floater like symptoms: in luxated & complete
mobile IOL
6.
Pupillary block glaucoma:
7.
Retinal trauma
mobile
in luxated & complete
(in luxated & complete mobile)
IOL dislocation
Evaluation:
Accompanying complications
 Inflammation
 increased IOP
 Vitreous incarceration
 Retinal damage
 CME
IOL dislocation
management:
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The best approach must be
determined individually and is based
on factors such as clinical
circumstances and coexisting
complications
Methods (non surgical, surgical)
Time of surgery
Method of surgery
IOL dislocation
management:
Non surgical management
 Observation is usually recommended for
IOLs with simple decentration
 If aphakic contact lens correction is
satisfactory,
 If systemic or ocular problems prohibit
further Surgery
 If the patient simply elects not to pursue
further surgery
IOL dislocation
management
surgical management
 Usually non surgical methods is not
satisfactory or convenient to the
most of patients
IOL dislocation
Surgical management:
Indications
 decreased VA
 persistent CME
 Increased IOP and inflammation
 coexisting RD
 Retain lens material
 monocular diplopia
 halo phenomenon
 fluctuating vision caused by shifting IOL
IOL dislocation
Time of Surgical management
Optimal time for intervention
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intraoperative IOL dislocation:
IOL dislocation days after operation:
dislocations occurring distantly:
IOL dislocation
surgical management:
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IOL removal
IOL exchange
IOL repositioning
Secondary IOL
IOL dislocation
surgical management:
Surgical approach
 Limbal incision: in moderate decentration
or subluxated if post. capsule is largely intact

Pars plana vitrectomy:
In luxated IOL
offer optimal control to achieve the goal of surgery
in subluxated IOL specially if posterior migration
occurs
IOL dislocation
surgical management:
IOL removal
 RD
 Inflammation
 Trauma

IOL removal with or without exchange is
usually performed for IOLs with damaged haptics,
small optics, or highly flexible haptics unsuitable
for suture support
IOL dislocation
surgical management:
IOL exchange
 Risk of endothelial cell trauma
 Explantation & reimplantation may
risk more corneal endothelial trauma
compared with repositioning
 Exchange for an AC.IOL causes less
trauma to endothelial compared with
PC IOL placement
IOL dislocation
surgical managment:
IOL Repositioninig
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Most common elected approach
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Three basic approaches
1. In the residual bag or sulcus
2. iris suture fixation
3. Scleral fixation
Repositioning a PC IOL in AC may induce
chronic iritis, inflammation, and corneal
decompensation.
IOL dislocation
surgical managment
Secondary IOL:

(AC,PC) without explanation of
dislocation IOL only in unusual
circumstances
IOL dislocation
Outcomes & complications
Final outcomes depends on
 preoperative macular function
 Post operative complication of
original cataract surgery (CME & RD)
 Complication of final operation
IOL dislocation
Outcomes & complications
In some studies
 VA > 20/40
 Initial coexisting RD
 combined rate of RD
50-94%
0-10%
0-16%
IOL dislocation
Recommendation
1.
Anterior vitrectomy (avoid vitreous
incarceration)
2.
A second IOL should not be placed
3.
Frequent topical steroids
4.
If indicated IOP-reducing agent
5.
Vitreoretinal refferal
6.
Careful attention to detect other
complications