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  • Late In-the-Bag IOL Dislocation: Lens Repositioning vs. Lens Exchange

    By Marianne Doran and selected by George B. Bartley, MD
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    Journal Highlights

    Ophthalmology, February 2017

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    Kristianslund et al. carried out a pro­spective randomized parallel-group trial to compare the efficacy and safety of 2 surgical methods for managing late in-the-bag intraocular lens (IOL) dis­location: IOL repositioning by scleral suturing (i.e., repositioning) and IOL exchange with retropupillary fixation of an iris-claw IOL (i.e., exchange). They found that both methods yielded satisfactory—and not significantly different—best-corrected visual acuity (BCVA) at 6 months.

    This study involved 104 patients (104 eyes) with IOL dislocation more than 6 months after implanta­tion. Of these, 54 eyes were assigned to repositioning and 50 were assigned to ex­change. All of the procedures were performed by the same surgeon between January 2013 and December 2015. Patients were assessed preoperatively and postoperatively; parameters included the following: presence/absence of pseudoexfoliation, corneal endothelial cell count, refrac­tion and BCVA, and degree of IOL dis­location. In addition, the postoperative examination recorded complications.

    The main outcome measure was BCVA at 6 months. There was no sig­nificant difference in BCVA between the 2 groups, both of which achieved a significant improvement after surgery. However, 21% and 26%, respectively, of patients in the repositioning and exchange groups experienced worse BCVA after the procedure.

    The researchers found both oper­ation methods to be generally safe, with a fairly low frequency of seri­ous perioperative and postoperative complications. The 2 most common postoperative complications were IOP increase (25% overall), with 12 cases (28%) in the repositioning group and 9 cases (21%) in the exchange group; and cystoid macular edema (8% overall), with 3 (7%) and 4 (10%) cases in the respective groups. Some complications varied between groups. The mean surgical time was longer for reposition­ing than for exchange. Furthermore, intraocular hemorrhage occurred only during repositioning, while iris injuries and the need for anterior vitrectomies occurred only during exchange; these differences were expected based on the specific surgical methods. Endothelial cell loss was significantly greater in the exchange group.

    The authors concluded that while both methods are acceptably safe, the specific complications vary between them. Thus, the surgeon should take these differences into consideration when selecting the most appropriate method for individual patients.

    The original article can be found here.