SPONTANEOUS LATE DISLOCATION OF INTRAOCULAR LENS WITHIN THE CAPSULAR BAG IN PSEUDOEXFOLIATION SYNDROME

PES has been associated with weakness of zonular attachments to the ciliary body and with late dislocation of the IOL following cataract extraction with in-the-bag IOL implantation. However, zonular disintegration and capsular shrinkage in pseudophakic PEG eyes may lead to easier IOL luxation or dislocation into the vitreous causing acute visual loss. We compare and evaluate the visual outcome and complication rate of two different techniques of surgical management of in-the-bag intraocular lens (IOL) dislocation or aphakia correction. in accordance with the improvement of surgical techniques, we compared sutureless and double flange  technique for IOL bag complex repositioning in IOL dislocation in pseudoexfoliative syndrome.

Eye Clinic “Prof. dr Ivan Stankovic” University Medical Center “Zvezdara”, Belgrade, Serbia

We retrospectively reviewed the records of seven patients who had undergone phacoemulsification, followed by implantation of a posterior chamber IOL in the capsular bag during the years 2015 through 2022 and who showed IOL dislocation during follow-up.  We aimed to evaluate the patient characteristics, expected visual outcomes, surgically induced astigmatism, and complications. For surgical treatments, we focused on the comparison of the 2 main operation methods: IOL repositioning suturelles intrascleral fixation and IOL repositioning double flange fixation.

The median age of eight patients was 59 years (range 47–72 years) and they were 2 women and 5 men. The median implantation duration of the dislocated IOLs was 10 years (range 4–22 years). Axial length of the diseased eye was measured as 24.83 mm (range 23.43-26.87 mm).

• 7 eyes (7 patients)
• Sex: 2 women, 5 men
• Age range from 47 to 72 years
• Mean postoperative follow-up: 29.5+ 3.6 weeks
• Mean postoperative refraction: − 1,23 ± 1,41 diopter sphere
• Postoperative astigmatism: -1.25 median (for -0,5 to 2)
• No intraoperative complications
• IOL was well centered and stable in all the patients
• No postoperative complications were registered (scleral necrosis, cystoid macular oedema, retinal detachment, endoftalmitis)

Late in-the-bag IOL dislocation occurs on average almost 10 years after cataract surgery with a cumulative incidence of 0.5% to 3%. In terms of treatment, some literature seems to indicate that IOL repositioning and IOL exchange have comparable efficacy in terms of visual outcome and that both have acceptable safety with few minor surgical complications. None of the operation methods seem superior to the others in all aspects and thus the best choice for all patients with late in-the-bag IOL dislocation. This paper shows that with the advancement of surgical techniques, therapeutic approaches are also changing in accordance with the functional effectiveness of surgical methods. However, increased knowledge is required before specific recommendations can be given.