Looming dis-located IOL epidemic

An increase in the rate of late intraocular lens dislocations occurring in Sweden and other countries may be partly due to the use of phacoemulsification in eyes in which extracapsular cataract surgery might be more appropriate, said Ulf Stenevi MD, Sweden, at the XXXII Congress of the ESCRS in Barcelona.

Dr Stenevi noted that 15 years ago late dislocations were uncommon enough to attract special interest when they occurred. But their rate of occurrence began to increase markedly starting around 2004.

As an example of the complications being encountered, he described the case of a man who had undergone uneventful phacoemulsification and eight years later had a dislocated IOL  in one eye and then a year later had a  dis-located IOL in the other eye.

He cited three studies carried out at different clinics in Sweden with extensive follow-up of large numbers of patients which indicate that the incidence appears to be around a half a per cent to one per cent of patients.

The studies also showed general agreement with other studies regarding the   risk factors for late IOL dislocation . The most important risk factor is pseudoexfoliation , others include concomitant eye disease, previous eye surgery, long axial length, and long phacoemulsification time.

He added that when he first presented his findings at the XXVI congress of the ESCRS in 2009, some were quick to christen the phenomena “the Swedish Syndrome”. However, they soon found that the rates of dislocations were rising in their own countries.

He suggested that the timing of the increased incidence of the late complication suggests that it is a delayed reaction to the adoption of phacoemulsification. He added that if current trends continue the number of patients affected annually will increase by 50 per cent.