Managing intraocular lens dislocation with one-port pars plana vitrectomy under direct vision with microscope illumination / 国际眼科杂志(Guoji Yanke Zazhi)

@#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.<p>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.<p>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.<p>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.

Clinical Outcomes of Combined Vitrectomy and Intrascleral Fixation of New Intraocular Lenses in In-the-bag Dislocations

PURPOSE: To investigate the clinical outcomes of combined vitrectomy and intrascleral fixation of a new posterior chamber intraocular lens (PC IOL) as a treatment for IOL dislocation. METHODS: We conducted a retrospective interventional study at our medical facility from January 2015 to January 2017. Posteriorly dislocated IOLs were removed with pars plana vitrectomy. Two intrascleral tunnels, 2.0 mm in length, were created 1.5 mm to the limbus at 6 and 12 o'clock positions. Both haptics of new foldable acrylic 3-piece IOLs were inserted into the tunnel until the IOL was secured in a central position. We analyzed the preexisting ocular condition, visual acuity (VA), and refractive error preoperatively and postoperatively, and recorded postoperative complications. RESULTS: Forty-nine patients (50 eyes) were enrolled in the study. The mean follow-up period was 12.8 ± 6.6 months. A best-corrected VA of 6/12 or better was achieved in 43 eyes (86%). The mean VA significantly improved from 0.32 logarithm of the minimum angle of resolution (logMAR) at baseline to 0.18 logMAR at last follow-up (p = 0.03). The refractive status after intrascleral fixation of the PC IOL revealed a mean hyperopic shift of +1.09 ± 1.28 diopters from the predicted spherical equivalent. Postoperative vitreous hemorrhages occurred in six cases and were cleared without visual compromise. Cystoid macular edema was well-controlled by topical nonsteroidal anti-inflammatory drugs (NSAID) medications in two cases. In two cases, IOL dislocation recurred and required re-operation. There were no serious adverse events of suture-related complications, retinal detachment, corneal compromise, or endophthalmitis in any of the patients. CONCLUSIONS: Our data revealed that use of combined vitrectomy and intrascleral fixation of PC IOLs is a safe and efficient technique to correct IOL dislocation. We observed good visual outcomes with only minor complications.

Research advances on late intraocular lens dislocation after phacoemulsification / 国际眼科杂志(Guoji Yanke Zazhi)

Late intraocular lens dislocation is one of the most severe late complications after phacoemulsification.It often occurs 3mo after the surgery.Different from early intraocular lens dislocation, late intraocular lens dislocation is caused by zonular dehiscence and contraction of the capsular bag many years after phacoemulsification.In recent years, the incidence of late intraocular lens dislocation gradually increases, having a risk of 0.1% after 10a and 1.7% after 25a.In the long-term follow-up patients who underwent cataract surgery, 90% had zonular insufficiency and capsular contraction.Among the multiple factors which may contribute to zonular weakness and capsular contraction, pseudoexfoliation is the most common cause, accounting for 50% of all the cases.Other risk factors include aging, high myopia, uveitis, trauma, previous vitreoretinal surgery, retinitis pigmentosa, diabetes mellitus, atopic dermatitis, previous acute angle-closure glaucoma attack, and connective tissue disorders.The understanding of these predisposing factors will suggest necessary preventions for high-risk patients in the future.

Predisposing Factors and Surgical Outcomes of Intraocular Lens Dislocation after Phacoemulsification

PURPOSE: To report the predisposing factors and surgical outcomes of intraocular lens dislocation (IOL) after phacoemulsification. METHODS: We performed a retrospective study of 131 eyes in 120 patients who were diagnosed with IOL dislocation after phacoemulsification between January 2008 and December 2013. The main outcomes are possible predisposing factors, characteristics of IOL dislocation, and outcomes of rectification surgery, including visual acuity (VA), and refractive status before and at 3 months after surgery. RESULTS: The main conditions associated with IOL dislocation were as follows: status after vitrectomy (27.5%), long axial length (9.2%), neodymium-doped yttrium aluminium garnet (Nd:YAG) posterior capsulotomy (8.4%), uveitis (6.1%), trauma (5.3%), mature cataract (3.8%), and pseudoexfoliation (2.3%). Mean uncorrected VA improved significantly after rectification surgery (p = 0.00), and best-corrected VA also improved significantly (p = 0.01). Mean value of spherical equivalent tended to decrease, although the decrease was not significant (p = 0.07). Whereas astigmatism showed a significant increase (p = 0.01). 6 eyes (4.6%) were associated with recurrence of IOL dislocation. CONCLUSIONS: Possible major predisposing factors for IOL dislocation are status after vitrectomy, long axial length, Nd:YAG posterior capsulotomy, uveitis, and trauma. The surgical outcome and improvement of postoperative visual acuity were satisfactory.

Golden half ring sign for identification of pseudophacocele.

Dislocation of intraocular lens (IOL) is a serious complication of blunt ocular trauma in pseudophakic eyes. Here, a 72‑year‑old male patient with subconjunctival dislocation of an IOL (pseudophacocele) secondary to bull horn injury was reported. In this case report, a new sign named as “golden half ring sign” was described for easy identification and localization of subconjunctival dislocation of IOL in patient with open globe injury (surgical wound dehiscence) associated dense subconjunctival hemorrhage.

Analysis of causes of the intraocular lens dislocation after trans-scleral fixation of intraocular lens / 中华实验眼科杂志

Background Trans-scleral fixation of intraoculalen(IOL) hamade greaprogress,buthe long-term stability of the implanposition of IOL aftesurgery inoideal.Objective Thistudy wato investigate the relevanfactorof IOL dislocation aftetrans-scleral fixation of IOL.Methodrespective case-observational study wadesigned.The clinical datfrom 321 eyeof 321 patientwho had received trans-scleral fixation of IOL were collected.total of 263 patientcompleted the effeetive follow-up,and 164 patientwith the follow-up fomore than 5 years.No IOL dislocation occurred within 5 yearin all 263 eyes.The relationship between IOL material,IOL implantation location,the time of IOL dislocation and the intraoculapressure with IOL dislocation were analyzed.ResultIOL dislocation appeared 7-10 yearaftesurgery in 9 eyewith an incidence rate of 5.49％.Breakage of IOL suture wafound in all the eyewith IOL dislocation.Dislocation wamore frequently found in IOL performed in the oblique position than thain the horizontal position (10.0％ vs.3.5％).The rate of IOL dislocation wahighesin traumatiretinal detachmeneyes,apercentage of 33.33％.Single piece IOL wamore easily dislocated.ConclusionThe breakage of anchosuturein IOL ileading cause of IOL dislocation aftetrans-scleral fixation of intraoculalens,which may be associated with the weighresulting from the fixation procesin non-level angulaIOL.Iirecommended thaIOL should be fixed in the horizontal position.

Bilateral Spontaneous Dislocation of Intraocular Lenses within the Capsular Bag in a Retinitis Pigmentosa Patient

A 45-year-old man with retinitis pigmentosa (RP), who had undergone uneventful extracapsular cataract extraction (ECCE) in his right eye eight years previously, and phacoemulsification in his left eye six years previously, had spontaneously dislocated intraocular lenses (IOL) within the capsular bag in both eyes one month apart. We removed the dislocated IOLs, and performed anterior vitrectomy and scleral fixation of the new IOLs. Mild contraction of the capsular bags and uneven distribution of the zonular remnants' clumps along the equator of the capsules were found by scanning electron microscopic (SEM) examination. In this study, we propose the correlation between RP and zonular weakness. To our knowledge, this is the first case report of bilateral spontaneous dislocation of IOLs within the capsular bag of an RP patient.