• News in Review

    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.

    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.

    Disclosure Category

    Code

    Description

    Consultant/Advisor C Consultant fee, paid advisory boards, or fees for attending a meeting.
    Employee E Employed by a commercial company.
    Speakers bureau L Lecture fees or honoraria, travel fees or reimbursements when speaking at the invitation of a commercial company.
    Equity owner O Equity ownership/stock options in publicly or privately traded firms, excluding mutual funds.
    Patents/Royalty P Patents and/or royalties for intellectual property.
    Grant support S 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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