Pseudoexfoliation is the most common risk factor for late in-the-bag IOL dislocation

This retrospective review analyzed 45 cases of spontaneous late in-the-bag IOL dislocation treated by one surgeon a single center between 2005 and 2009.

Mean interval to dislocation was 8.04 years. Pseudoexfoliation was the predisposing risk factor in 66.66 percent of eyes, uveitis in one eye, and a long axial length in one eye. There were no identifiable risk factors in 14 eyes (31.11 percent).  Eight eyes had in-the-bag IOL dislocation spite having a capsular tension ring (CTR) in the bag, confirming what I've found in the lab. Although it can reduce the degree of capsule contraction, the presence of a CTR does not prevent dislocation.

Good outcomes were achieved using a variety of surgical techniques: repositioning using scleral fixation or iris suturing, IOL exchange for an anterior chamber IOL or iris-claw IOL or anterior capsulotomy. The mean CDVA improved significantly postoperatively (P = 0.0001), and there was no significant difference in postoperative CDVA between scleral-fixated IOLs and anterior chamber IOLs (P = 0.316). Postoperative complications included a choroidal hemorrhage, two cases of vitreous hemorrhage that resolved spontaneously, and three cases of pupillary block, all of which occurred in cases of AC IOLs and were successfully treated with laser iridotomy.

Although used in a small number of cases, the authors conclude that the iris-claw IOL, an option not considered previously, seems a promising alternative in the surgical management of this condition. They also strongly recommend early surgical intervention and close monitoring of eyes with pseudophakodonesis.