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.”
1 Dalby M et al. Am J Ophthalmol. Published online June 10, 2019.
Relevant financial disclosures—Dr. Masket: None.
For full disclosures and the disclosure key, see below.
Full Financial Disclosures
Dr. Berkenstock None.
Dr. Chew None.
Dr. Masket Accutome: S; Alcon: C,L; CapsuLaser: C,O; Haag-Streit: C,P; Morcher: P; Ocular Science: C,O; Ocular Theraputix: C,O; PowerVision: C; VisionCare Ophthalmic Technologies: C.
Dr. Naidoo AstraZeneca/MedImmune: C,L,S; Bristol-Myers Squibb: C,L; Calithera: S; Kyowa Hakko Kirin: S; Merck: S; Takeda: C.
Dr. Rowan None.
Dr. Taylor None.
||Consultant fee, paid advisory boards, or fees for attending a meeting.
||Employed by a commercial company.
||Lecture fees or honoraria, travel fees or reimbursements when speaking at the invitation of a commercial company.
||Equity ownership/stock options in publicly or privately traded firms, excluding mutual funds.
||Patents and/or royalties for intellectual property.
||Grant support or other financial support to the investigator from all sources, including research support from government agencies (e.g., NIH), foundations, device manufacturers, and/or pharmaceutical companies.
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