Intraocular Lens (IOL) Dislocation Follow-up

Updated: May 12, 2021
  • Author: Lihteh Wu, MD; Chief Editor: John D Sheppard, Jr, MD, MMSc  more...
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Follow-up

Further Outpatient Care

Patients should receive follow-up care as needed.

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Deterrence/Prevention

A study by Tappin et al examined some of the intraoperative and postoperative factors leading to IOL decentration in patients requiring IOL exchange in an attempt to identify avoidable causes of IOL decentration. [8] They concluded that significant postoperative subluxation of injected silicone IOLs may be minimized by implanting only into a lens capsule bag with an intact capsulorrhexis. The risk of decentration of a small optic (5.5 mm) PMMA IOL may be minimized by positioning the haptics at 90° to any capsulorrhexis tear. After cataract surgery complicated by posterior capsular rupture or zonular dehiscence, it is important to assess the remaining capsular support and, if sufficient, implant a large optic diameter (7 mm) PCL in the ciliary sulcus.

The anterior segment surgeon should be advised to avoid implantation of a flexible silicone plate IOL if there is a break in the posterior capsule, radial notch, or tear in the anterior capsular rim or zonular dialysis.

Small capsulorrhexis openings should be avoided.

Current models of ACIOLs often do not result in the same types of complications as older models. These lenses should be considered if adequate capsular support is lacking rather than risking a posterior dislocation of an IOL.

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Complications

Complications from a decentered IOL

Complications associated with ACIOL, iris-fixated IOLs, and older PCIOLs are much more severe than those encountered with modern PCIOL decentration. Corneal edema and inflammatory consequences such as uveitis-glaucoma-hyphema syndrome and chronic CME were common reasons for explanation in the above cases.

Complications from a dislocated IOL

Complications associated with dislocated IOL include the following:

  • Vitreous hemorrhage
  • Retinal detachment has been estimated to occur in at least 2% of cases. It frequently is caused by attempts at relocation by the cataract surgeon or as a complication of vitreoretinal surgery.
  • Cystoid macular edema
  • Uncorrected aphakia, glare, or distortion

Complications from transscleral suture fixation

Late endophthalmitis through the suture track has been reported.

IOL torque may occur. In addition, to place the IOL truly in the sulcus, the suture must be placed 0.8 mm posterior to the limbus in the vertical meridian and 0.46 mm in the horizontal meridian. The effective lens power is probably less than the desired one.

Vitreous hemorrhage may occur if the major arterial circle of the iris is pierced inadvertently during the maneuvers required to suture the IOL. In addition, these maneuvers also may raise the risk of a postoperative retinal detachment.

Erosion of the suture through the conjunctiva also has been reported in cases where scleral flaps were used. An attempt to melt the eroded sutures with the argon laser has been recommended. The sutures cannot be removed because the IOL haptics do not scar into place if placed in the ciliary sulcus. Once the sutures are removed, the IOL will redislocate.

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Prognosis

With proper vitreoretinal techniques, excellent visual results and a low complication rate is possible. Long-term prognosis is highly dependent on the prevention of retinal detachment and choroidal hemorrhage secondary to surgical manipulation.

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