Vitreoretinal surgery in patients with intraocular lens dislocation into the vitreous

Aim: To evaluate the demographic and clinical characteristics of patients who underwent pars plana vitrectomy (PPV) for intraocular lens (IOL) dislocation into the vitreous cavity and the visual and anatomical outcomes of PPV in these patients. Material and Methods: This retrospective study reviewed the files of patients who underwent PPV for IOL dislocation into the vitreous in our clinic between January 2014 and December 2018. Patient age, gender, preoperative and postoperative best corrected visual acuity (BCVA), intraocular pressure (IOP), comorbid ocular pathologies, causes of IOL dislocation, time from IOL dislocation to PPV surgery, surgical methods, and preoperative and postoperative complications were recorded. Results: This study included 15 eyes of 15 patients with IOLs dislocated into the vitreous, of which 5 (33.3%) were female and 10 (66.7%) were male. Mean patient age was 60.8±22.67 (12-94) years. Seven (46.7%) of 15 eyes underwent a secondary IOL implantation in the same session as IOL extraction, whereas eight eyes were planned to undergo a secondary IOL implantation in a second session. Meanwhile, 2 (13.3%) eyes did not undergo IOL implantation. Median preoperative BCVA was 1.7 (0.4-1.92) logMAR and median postoperative BCVA was 0.5 (0-2) logMAR across all patients (p=0.002). After surgery, BCVA was higher in 12 patients (80%), unchanged in 2 patients (13.3%) and lower in one patient (6.7%). In our series, 3 eyes were detected to have preoperative RD and 2 eyes high IOP, whereas one patient showed recurrent RD and 4 eyes showed high IOP postoperatively. Median postoperative BCVA was significantly higher in patients who underwent secondary IOL implantation in a second session than those who underwent IOL implantation in the same session (p=0.035). Conclusion: PPV is a safe method for achieving successful visual and anatomical outcomes in patients with IOL dislocated into the vitreous cavity. In these patients, performing the secondary IOL implantation in a second session can result in a higher final visual acuity. Also, monitoring these complex cases closely is important in order to achieve better visual and anatomical outcomes.

PDF

___

1. Lee CM, Afshari NA. The global state of cataract blindness. Curr Opin Ophthalmol 2017;28:98-103.
2. Wang SY, Stem MS, Oren G, et al. Patient-centered and visual quality outcomes of premium cataract surgery: A systematic review. Eur J Ophthalmol 2017;27:387- 401.
3. Gimbel HV, Condon GP, Kohnen T, et al. Late in-the-bag intraocular lens dislocation: Incidence, prevention, and management. J Cataract Refract Surg 2005; 31:2193-204.
4. Moran S, Kirwan C, O’Keefe M, et al. Incidence of dislocated and subluxed iris-fixated phakic intraocular lens and outcomes following re-enclavation. Clin Exp Ophthalmol 2014;42:623-8.
5. Hayashi K, Hirata A, Hayashi H. Possible predisposing factors for in-the-bag and out-of-the-bag intraocular lens dislocation and outcomes of intraocular lens exchange surgery. Ophthalmology 2007;114:969-75.
6. Vazquez-Ferreiro P, Carrera-Hueso FJ, FikriBenbrahim N, et al. Intraocular lens dislocation in pseudoexfoliation: A systematic review and metaanalysis. Acta Ophthalmol 2017;95:e164-9.
7. Shigeeda T, Nagahara M, Kato S, et al. Spontaneous posterior dislocation of intraocular lenses fixated in the capsular bag. J Cataract Refract Surg 2002; 28:1689-93.
8. Flynn HW Jr. Pars plana vitrectomy in the management of subluxated and posteriorly dislocated intraocular lenses. Graefe’s Arch Clin Exp Ophthalmol 1987;225:169-72.
9. Kokame GT, Yamamoto I, Mandel H. Scleral fixation of dislocated posterior chamber intraocular lenses: Temporary haptic externalization through a clear corneal incision. J Cataract Refract Surg 2004;30:1049-56.
10. Serif N, Ozdek S, Gurelik G, et al. [Surgical treatment modalities and outcomes of dislocated IOLs into the vitreous.] Ret-Vit 2006;14:181-4.
11. Ascaso FJ, Huerva V, Grzybowski A. Epidemiology, Etiology, and Prevention of Late IOL-Capsular Bag Complex Dislocation: Review of the Literature. J Ophthalmol 2015; 2015:5706.
12. Davis D, Brubaker J, Espandar L, et al. Late in-the-bag spontaneous intraocular lens dislocation: Evaluation of 86 consecutive cases. Ophthalmology 2009; 116:664-70.
13. Hazzazi MA, Rashaed SA. Outcomes and Determinants of Posterior Dislocated Intraocular Lens Management at a Tertiary Eye Hospital in Central Saudi Arabia. Middle East Afr J Ophthalmol 2019;26:223-8.
14. Gross JG, Kokame GT, Weinberg DV. Dislocated In -The- Bag Intraocular Lens Study Group. In -TheBag intraocular lens dislocation. Am J Ophthalmol 2004;137:630-5.
15. Kayikcıoglu O, Seymenoglu G, Cinali M. Review of cases with intraocular lens and nucleus drop into the vitreous cavity. Ret-Vit 2008;16:250-4.
16. Kim SS, Smiddy WE, Feuer W, Shi W. Management of dislocated intraocular lenses. Ophthalmology 2008;115:1699-704.
17. Soba DO, Citirik M, Demircan E, Yilmazbas P. Vitreoretinal Surgery for Intraocular Lens Dislocated into the Vitreous Cavity. Turk J Ophthalmol 2015;45:56-9.
18. Dundar H, Yuksel K, Altinkaynak H, et al. 23-Gauge Transconjunctival Sutureless Vitrectomy in Eyes with Posteriorly Dislocated Intraocular Lens. Turk J Ophthalmol 2013; 43:99-102.
19. Smiddy WE, Ibanez GV, Alfonso E, Flynn HW Jr. Surgical management of dislocated intraocular lenses. J. Cataract Refract Surg 1995; 21:64-9.
20. Shingleton BJ, Yang Y, O’Donoghue MW. Management and outcomes of intraocular lens dislocation in patients with pseudoexfoliation. J Cataract Refract Surg 2013;39:984-93.
21. Yang CS, Chao YJ. Long-term outcome of combined vitrectomy and transscleral suture fixation of posterior chamber intraocular lenses in the management of posteriorly dislocated lenses. J Chin Med Assoc 2016; 79:450-5.
22. Al-Halafi AM, Al-Harthi E, Al-Amro S, El-Asrar AA. Visual outcome and complications of pars plana vitrectomy for dislocated intraocular lenses. Saudi J Ophthalmol 2011;25:187-92.
23. Sarrafizadeh, R, Ruby AJ, Hassan TS, et al. A comparison of visual results and complications in eyes with posterior chamber intraocular lens dislocation treated with pars plana vitrectomy and lens repositioning or lens exchange. Ophthalmology 2001;108:82-88.
24. Singh R, Bhalekar S. Repositionig a dislocated intraocular lens in the ciliary sulcus using 23- gauge sutureless pars plana vitrectomy. J Cataract Refract Surg 2011;37:438-40.
25. Steinmetz RL, Brooks HL Jr, Newell CK. Management of posteriorly dislocated posterior chamber intraocular lenses by vitrectomy and pars plana removal. Retina. 2004;24:556-9.
26. Smiddy WE. Management of dislocated foldable intraocular lenses. Retina 2005; 25:576-80.
27. Akca Bayar S, Yılmaz G. Dislocation of Lens Fragments Into the Vitreous Cavity During Cataract Surgery and IOL Luxations. Ret-Vit 2010;18:1-7.
28. Campo RV, Chung KD, Oyakawa RT, et al. Pars plana vitrectomy in the management of dislocated posterior chamber lenses. Am J Ophthalmol 1989;108:529-34.
29. Mittra RA, Connor TB, Han DP, et al. Removal of dislocated intraocular lenses using pars plana vitrectomy with placement of an open-loop, flexible anterior chamber lens. Ophthalmology 1998;105:1011-4.
30. Cho BJ, Yu HG. Surgical outcomes according to vitreous management after scleral fixation of posterior chamber intraocular lenses. Retina 2014;34:1977-84.