JCRS HIGHLIGHTS

Late in-the-bag intraocular lens (IOL) dislocation is a serious complication of cataract surgery that usually requires surgical management. Previous studies have identified pseudoexfoliation as one of the main risk factors for zonular weakness and, as a consequence, spontaneous in-the-bag IOL dislocation. Other risk factors are believed to include uveitis, previous vitreoretinal surgery, increased axial length (AL), age, certain connective tissue disorders, retinitis pigmentosa, and zonular dehiscence during cataract surgery.

With concern growing that the number of surgeries for late IOL dislocations has increased in recent years, Swedish researchers reviewed 21 years of surgical records in an attempt to identify the incidence and risk factors for this problem. The annual incidence varied between 0.00 per cent and 0.08 per cent. The cumulative risk five, 10, 15 and 20 years after cataract extraction was 0.09 per cent, 0.55 per cent, 1.00 per cent and 1.00 per cent, respectively, and was significantly higher (P < .001) in eyes that had cataract surgery between 2002 and 2012 than in those operated earlier. The calendar time (date) of dislocation was positively correlated with the duration of preceding pseudophakia. Phacoemulsification time was longer in eyes with dislocation than in control eyes (P < .001). Other identified risk factors were pseudoexfoliation, zonular dehiscence, pseudophacodonesis, and increased AL. The study did not include refractive lens extraction (RLE) cases, as these are rarely performed in public healthcare, although the number of middle-aged patients having RLE is increasing worldwide.

K Dabrowska-Kloda et al, JCRS, “Incidence and risk factors of late in-the-bag intraocular lens dislocation: Evaluation of 140 eyes between 1992 and 2012”, In Press, June 2015.

MANAGING REFRACTIVE ERROR FOLLOWING CATARACT SURGERY

Surgeons seeking to manage refractive error following cataract surgery have many options, but which is best? A new comprehensive literature review looked at existing options such as LASIK, photorefractive keratectomy (PRK), arcuate keratotomy, intraocular lens (IOL) exchange, piggyback IOLs and light-adjustable IOLs. The reviewers had several recommendations. First, they suggest that all patients be counselled in advance that uncorrected distance acuity may fall short of 20/20. Piggyback IOLs appear to be an effective approach for large spherical errors with or without astigmatism. For small spherical errors with or without astigmatism, both LASIK and PRK are safer, more effective and more predictable than intraocular approaches. The same is true for astigmatism. Laser vision correction is also useful after ametropia following implantation of a multifocal IOL. Wavefront-guided treatments do not appear to be superior to conventional treatments in these cases. Finally, the researchers note that the light-adjustable IOL does look very promising for preventing dreaded refractive surprises in post-refractive-surgery patients.

CS Sales et al, JCRS, “Managing residual refractive error after cataract surgery”, In Press, June 2015.