Managing intraocular lens dislocation with one-port pars plana vitrectomy under direct vision with microscope illumination

AIM: To describe a technique of managing intraocular lens (IOL) with deep dislocation in the vitreous cavity by performing pars plana vitrectomy (PPV) with only one pars plana incision under the direct illumination of the surgical microscope. METHODS: Patients who had in-the-bag or out-of-the-bag (spontaneous) IOL dislocation after uneventful phacoemulsification cataract extractions, with the dislocated IOL or IOL-capsular bag complex dropping completely into the vitreous since 2013 were included in our studies. The postoperative patients were followed up for 6mo. Detailed description of technique and retrospective description of eight typical cases were demonstrated in this study. RESULTS: A total of 40 surgeries were conducted using this technique. The main possible predisposing conditions included: post-vitrectomy, posterior capsule rupture or broken zonules, a history of ocular trauma, long axial length, secondary IOL implantation, chronic uveitis, retinitis pigmentosa and post-glaucoma surgery. In all eyes, the IOLs were successfully removed. No intraoperative or postoperative complications related to the procedures occurred. The preoperative corrected distance visual acuity (CDVA) ranged from 20/133 to 20/25, and at 6mo postoperatively, the CDVA was similar or the same. The intraocular pressure was all within the normal range. CONCLUSION: One-port PPV under direct vision with microscope illumination is a simple and safe surgical technique to managing IOL dislocation, which shortens the surgical time, and largely avoids surgical complications.

Outcomes of the flanged intrascleral haptic fixation with double-needle technique in patients with Marfan syndrome

Purpose: To investigate the clinical outcomes and complications associated with the flanged intrascleral haptic fixation with double-needle technique (a.k.a. the Yamane technique/FIHFT) in patients with Marfan syndrome (MFS) with subluxated or dislocated lenses. Methods: Eighteen eyes of 11 patients with MFS with subluxated or dislocated lenses who had undergone intraocular lens implantation using the FIHFT from March 2019 to October 2020 were evaluated. All patient data were retrospectively collected from medical records, including a complete ophthalmologic examination at baseline and follow-up examinations of uncorrected visual acuity (UCVA, logMAR), best-corrected visual acuity (BCVA, logMAR), intraocular pressure (IOP), and slit-lamp examination. Results: The median follow-up period was 6 ± 3 (range, 3–12) months. The average patient age at the time of surgery was 13 ± 9 (range, 4–34) years. The mean preoperative BCVA was 0.49 ± 0.20 logMAR (Snellen equivalent visual acuity, 20/60), while the mean postoperative BCVA at the end of follow-up was 0.21 ± 0.14 logMAR (20/30), indicating an improvement of 0.28 ± 0.20 logMAR (20/40) postoperatively ( p < 0.001). Postoperative iris capture occurred in six eyes (38.9%). No cases of hypotony, IOP elevation, or vitreous hemorrhage were noted, and no patients developed intraocular lens dislocation, retinal detachment, or endophthalmitis. Conclusions: To our knowledge, the present study is the first to report outcomes of the FIHFT in patients with MFS. Our findings suggested that scleral lens fixation is safe and effective for improving visual acuity in patients with MFS who have subluxated or dislocated lenses.

Incidence and Characteristics of Intraocular Lens Dislocation after Phacoemulsification: An Eight-Year, Nationwide, Population-Based Study

Background: We investigate the incidence and characteristics of IOL dislocation among the pseudophakic population after phacoemulsification. Methods: National data were collected from the health claims recorded with the Health Insurance Review and Assessment Service of South Korea from 2009 to 2016. Pseudophakic patients aged 40 years or older were included. The incidence estimates of phacoemulsification and IOL dislocation were analyzed, and the cumulative probabilities of IOL dislocation among the pseudophakic population and general population were calculated as a proportion. Results: Of 51,307,821 total subjects, 25,271,917 of whom were aged 40 years or older, 3,906,071 cataract cases in 2,650,104 pseudophakic patients were identified, and 72,309 patients experienced IOL dislocation. The cumulative probability was 2.73% per person and 1.85% per surgery among patients 40 years of age or older. The eight-year incidence rate for IOL dislocation in the pseudophakic population aged 40 years or older was 7671 per 1,000,000 person-years (95% CI: 7616–7727), including 10,341 cases in men and 5814 in women. Incidence peaked in the seventh decade of life for cataract surgery but in the fifth decade of life for IOL dislocation. The cumulative probability of IOL dislocation after phacoemulsification was approximately 2%, and the incidence rate was about 7000 per 1,000,000 pseudophakic patients. Conclusions: There was a significantly higher incidence of IOL dislocation among young males, even though the higher incidence of cataract surgery was observed among older females. These estimates of the nationwide, population-based incidence of IOL dislocation can help increase understanding of the population vulnerable to IOL dislocation.

Late intraocular lens dislocation. Retrospective study

Purpose. To analyze the frequency, terms and risk factors of late IOL dislocation. Material and methods. A retrospective cohort study was conducted based on archival data of 70 787 cases of the senile cataracts phacoemulsifications performed in 2002–2019 years. Statistical processing of the results and Kaplan–Meier analysis were performed using the SPSS 11.0 program (STATA). Results. 320 patients in the study group were treated for late IOL dislocation at various postoperative periods. The average age of the patients was 76.2±12.5 years at the moment of reconstruction procedure. The periods from the moment of IOL implantation to its dislocation varied from 4 months to 17.58 years, the average term was 6.95±3.67 years. IOL reposition was performed in 272 cases (85.0%) and IOL change – in 48 cases (15.0%). The leading risk factor was pseudoexfoliation syndrome detected in 239 patients (74.7%). Among other factors there was high myopia (72 patients; 22.5%), in 78 cases there were the surgery procedures between cataract surgery and IOL dislocation: glaucoma surgeries – 27 cases (8.4%), vitreal surgeries – 9 cases (2.8%), laser discission of secondary cataract – 42 cases (13.1%). The cumulative 5-, 10-, 15-, and 18- year risk of late IOL dislocation was estimated using Kaplan–Meier analysis. Conclusion. The dynamics of the number of reconstructive operations at late IOL dislocations has a tendency to increase. The average term from the IOL implantation to its dislocation was 6,95±3,67 years. The leading risk factor was pseudoexfoliation syndrome. The cumulative 5-, 10-, 15-, and 18-year risk of late IOL dislocation was 0.2; 0.7; 1.15; and 1.4%, respectively. Key words: intraocular lens, dislocation, phacoemulcification.