To present the visual outcome and postoperative complications of pars plana vitrectomy and intraocular lenses (IOL) removal with or without IOL exchange of late in-the-bag IOL dislocation after uneventful cataract surgery.
Retrospective analysis of a consecutive series of 83 eyes with late in-the-bag dislocated IOL treated with pars plana vitrectomy and anterior chamber IOL (25 eyes), transscleral suture-fixated posterior chamber IOL (38 eyes), or aphakia (20 eyes).
High myopia was the major predisposing factor (40%). The interval between cataract surgery and the dislocation was 10.9 years. The complication rate after the second surgery was 43%; being transient hypotony (19%) and hypertension (15%) the most frequent. Postoperative best-corrected visual acuity improvement was statistically significant (P < 0.001), with a mean of 3 Snellen lines. This improvement was also significant in 2 subgroups, patients with sutured posterior chamber IOL (20/80–20/40; P < 0.001) and in patients with anterior chamber IOL (20/125–20/40; P < 0.001). However, best-corrected visual acuity did not improve in aphakic patients (20/63–20/63; P = 0.13). Postoperative astigmatism increased significantly (P < 0.001), with a mean of −1 D. Mean follow-up was 24 months.
The major predisposing factor for late in-the-bag IOL dislocation is myopia. Despite a complication rate of 43%, mostly minor and transient, IOL exchange surgery is an effective procedure with a good visual outcome (mean 3 Snellen lines improvement). There were no statistically significant differences in the final best-corrected visual acuity or complication rate between anterior chamber IOL and sutured posterior chamber IOL, thus, both surgical techniques may be considered to treat this condition.
Late in-the-bag intraocular lens dislocation into the vitreous cavity is an uncommon but serious complication. Several surgical techniques have been described, but more scientific evidence is needed to support a surgical decision in each case.
Department of Ophthalmology, Institut Catala de Retina, Barcelona, Spain.
Reprint requests: Amanda Rey, MD, PhD, Department of Ophthalmology, Institut Català de Retina, Ganduxer, 117, 08022 Barcelona, Spain; e-mail: email@example.com
None of the authors have any financial/conflicting interests to disclose.