Surgical repositioning for late IOL dislocation appears safe, effective

This prospective, nonrandomized study found that repositioning surgery for late IOL dislocation using scleral sutures is generally safe and effective, resulting in few complications and improving vision in most patients.

Subjects included 89 consecutive patients (91 eyes) having surgery for late in-the-bag or out-of-the-bag IOL dislocation during a two-year period at a university hospital in Sweden. IOLs were repositioned using scleral sutures in 94 percent of eyes, with a posterior approach, including pars plana vitrectomy, used in 76 percent of cases. The median follow-up was 17 months.

Pseudoexfoliation was detected in 57 percent of eyes. A significant decrease in IOP (mean 3.0 mmHg) was seen in glaucoma patients. Thirteen eyes had additional surgical procedures. Three cases of retinal detachment occurred.

CDVA improved by 0.13 logMAR. Twenty-one eyes (23.1 percent) had worse CDVA after IOL repositioning surgery. Five of these cases had severe visual loss, with a CDVA less than Snellen 0.05; in three eyes (two cases of retinal detachment and one of central retinal vein occlusion), this was due to new pathology.

The authors note that one important complication not evaluated in this study because it requires a longer follow-up is recurrent dislocation five to 10 years after IOL dislocation surgery.

They conclude that repositioning with scleral sutures or IOL exchange with iris-supported secondary IOL implantation, the predominant techniques used today, may not be sufficient for restoring the level of visual capacity patients demand. Moreover, many new IOLs are designed for intracapsular support only and are not always suitable for repositioning with scleral sutures. There will be a need for enhanced surgical procedures to provide optimum positioning and long-term IOL fixation in a growing pseudophakic population with individually calculated IOLs, even after surgery for a dislocated IOL.