Dislocated IOLs: Outcomes Equal With Two Techniques

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When it comes to fixing late in-the-bag disloca­tions of IOLs, Norwegian researchers found equivalent visual outcomes at two years after surgery with both scleral suturing of the existing lens and IOL exchange using a retropupillary iris-claw lens.¹

“An important implication of this trial is that patients with late in-the-bag IOL dislocation have an overall good visual prognosis when treated surgically, and the degree of dislocation at baseline (grade 1-3) did not affect the long-term visual outcome,” the researchers reported.¹

Retrospective studies have found long-term vision-threatening complications after IOL dislocation surgery, the researchers noted. But the results from this pro­spective, randomized trial found this not to be the case.

The study was well-designed, according to Samuel Masket, MD. “The key message is that the surgical methods are equivalent and that both can have a place in our armamentarium,” said Dr. Masket, in practice in Los Angeles. “Unfortunately, the Artisan [iris-claw] IOL is not available in the United States at this time. How­ever, an FDA trial is underway, and hopefully the device will receive approval in the foreseeable future.”

Study specifics. The Norwegian trial randomly as­signed 104 older patients to have their dislocated IOLs either sutured in place or replaced with an iris-claw lens (Verisyse VRSA54, Johnson & Johnson). Of the 104 patients, 66 (mean age, 79.6 ± 7.6 years) completed two years of follow-up. No statistically significant differ­ences in postoperative complications or visual acuity were noted between eyes in the two groups.

Adverse outcomes. Cystoid macular edema occurred in four scleral-fixation eyes and five iris-claw eyes. In addition, there was one re-dislocated IOL in each group. No retinal detachments occurred.

Visual acuity. The mean corrected distance visual acuity (CDVA) was logMAR 0.20 ± 0.29 SD (range: –0.18 to 1.10) in the scleral-fixation eyes and 0.22 ± 0.30 SD (range: –0.10 to 1.22) in the iris-claw group. Four patients in each group had a worse CDVA after surgery compared to baseline.

Unanswered questions. Dr. Masket said the study does not clarify the relative values of other methods of stabilizing a dislocated IOL. “There are a host of other methods that were not considered,” including intrascler­al haptic fixation, anterior chamber IOLs, and scleral suture fixation of IOLs (with eyelets) that are specifically designed for that purpose, he said.

“Perhaps large-scaled, multicentered randomized trials for all of these methods will be designed and performed to determine if there is a superior choice,” Dr. Masket said. “In the interim, surgeons can be com­fortable with either of the methods considered in the Norwegian study.”

—Linda Roach

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1 Dalby M et al. Am J Ophthalmol. Published online June 10, 2019.

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Relevant financial disclosures—Dr. Masket: None.

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