Consistent pattern in positional instability of polyfocal full-optics accommodative IOL.

PURPOSE: We describe cases of dislocation or subluxation of the WIOL-CF® polyfocal full-optics intraocular lens (IOL) and suggest a consistent pattern and possible mechanism for the IOL instability. METHODS: This is a retrospective case series of five consecutive eyes in three patients with WIOL-CF® IOL instability at Keimyung University Dongsan Medical Center and Kimkisan Eye Center from 2012 to 2014. The medical records and ocular exam data for these patients were analyzed. RESULTS: A 50-year-old male had uneventful phacoemulsification in both eyes with WIOL-CF® IOL implantation. At 27 months after surgery, the patient was referred to our clinic with a dislocated IOL in the left eye. The IOL in the right eye was dislocated in the same pattern 38 months after cataract surgery. Another 50-year-old male, who had phacoemulsification and WIOL-CF® IOL implantation in both eyes, was referred to our clinic following diagnosis of a subluxated IOL. Both IOLs were well centered; however, the infranasal aspect of the IOLs tilted posteriorly, and the supratemporal portion the IOLs tilted anteriorly, with overlying iris atrophy in a symmetric pattern. The inferonasal continuous curvilinear capsulorrhexis (CCC) edge was dragged superotemporally, and the supratemporal CCC edge was identified on the posterior surface of the IOL. A 16-year-old female had uneventful phacoemulsification and WIOL-CF® IOL implantation to treat a cataract in the right eye, and 3 years later, the IOL tilted with the same pattern as the previous case. CONCLUSIONS: Years after uncomplicated phacoemulsification, an implanted WIOL-CF® IOL may tilt and dislocate in the absence of trauma, in a consistent and characteristic pattern.

Asymptomatic haptic migration of phakic anterior chamber intraocular lens through the peripheral iridectomy.

OBJECTIVE: Case series of haptic migration in patients with angle-supported phakic anterior chamber intraocular lens (PAC-IOL: Phakic6H) through the superior peripheral iridectomy (PI). METHODS: Charts of 23 patients (35 eyes) with at least 6 months' postoperative follow-up were retrospectively reviewed. Evaluation included preoperative and postoperative cycloplegic and manifest refractions, uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), slit-lamp examination, fundoscopy, corneal topography, and biometry. RESULTS: Mean UCVA was 1.67 ± 0.30 (1.17-2.00) for all 35 eyes preoperatively and 0.35 ± 0.25 (0.00-1.00) postoperatively (p < 0.001; 95% CI 1.21-1.44). BCVA had a mean of 0.31 ± 0.26 for all 35 eyes preoperatively, and a mean of 0.22 ± 0.25 postoperatively (p < 0.001; 95% CI 0.04-0.14). Haptic migration into the superior PI was noted in 8 eyes (23%). The first migration was noted 2 years postoperatively and the last 8 years after implantation (mean, 5.6 ± 2 years). There was no statistically significant difference in the BCVA and UCVA before and after haptic migration. Follow-up ranged from 8 months to 8.5 years. CONCLUSIONS: Angle-supported PAC-IOL implantation resulted in significant improvement in both UCVA and BCVA. However, there is a 23% incidence of haptic migration in our series with no sequelae on BCVA or harmful effect on the intraocular structures. This IOL movement may be explained by changes in aqueous dynamics at the level of the PI leading to migration of the haptic into the area of least resistance.

Pathologic evidence of pseudoexfoliation in cases of in-the-bag intraocular lens subluxation or dislocation.

PURPOSE: To provide complete histopathologic evaluation of explanted capsular bags that spontaneously dislocated in the late postoperative period, with the main objective being to assess the presence of pseudoexfoliation (PXF) material. SETTING: Goethe-University Frankfurt, Frankfurt, Germany, and John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA. DESIGN: Retrospective case series. METHODS: Standard gross and light microscopy and complete histopathology were performed on explanted subluxated and dislocated capsular bags containing an intraocular lens (IOL) or a capsular tension ring (CTR) and an IOL. Questionnaires were sent to explanting surgeons, and a patient chart review was performed, when available. RESULTS: The specimens were represented by capsular bags containing an IOL (n = 37) or an IOL-CTR (n = 3). The IOLs included 3-piece hydrophobic acrylic (n = 13), 1-piece hydrophobic acrylic (n = 7), 3-piece silicone (n = 6), 1-piece hydrophilic acrylic (n = 6), 3-piece hydrophilic acrylic (n = 2), and 1-piece poly(methyl methacrylate) (PMMA) (n = 6) designs; all CTRs were PMMA. Soemmering ring formation was mild in 8 specimens, moderate in 18 specimens, and severe in 14 specimens. Excessive contraction of the capsular bag with capsulorhexis phimosis was observed in 24 specimens. Twenty-six specimens had histopathologic evidence of PXF; 13 had a clinical history or evidence of PXF. CONCLUSIONS: Pseudoexfoliation might be implicated in a larger proportion of late in-the-bag IOL subluxations and dislocations than previously thought as a result of significant clinical underdiagnosis. This might indicate a need for new considerations during the preoperative and postoperative cataract surgery assessments and follow-up.

In-the-bag capsular tension ring and intraocular lens subluxation or dislocation: a series of 23 cases.

OBJECTIVE: To describe clinical and pathologic findings from cases of in-the-bag capsular tension ring (CTR) and intraocular lens (IOL) subluxation or dislocation. DESIGN: Retrospective case series with clinicopathologic correlation. PARTICIPANTS: Twenty-three explanted subluxated/dislocated capsular bags containing a CTR and an IOL explanted in Europe and submitted in fixative to the Berlin Eye Research Institute. METHODS: Standard gross and light microscopy of specimens, complete histopathologic analyses of selected specimens done at the University of Utah, as well as questionnaire sent to explanting surgeons, and patient chart review, when available. MAIN OUTCOME MEASURES: Lens design, material, and abnormalities, capsular bag anomalies, patient demographic data, surgical dates, and presence or absence of known risk factors. RESULTS: Patients were aged 76.31 ± 8.24 years at explantation, which was performed 81.5 ± 32.2 months after implantation. The IOLs in these cases were 3-piece hydrophobic acrylic (N = 11), 1-piece hydrophobic acrylic (n = 6), 3-piece silicone (n = 4), or 1-piece hydrophilic acrylic (n = 2) designs; all CTRs were made of poly(methyl methacrylate). Available information on associated ocular conditions included pseudoexfoliation (n = 17), glaucoma (n = 4), vitrectomy/retina surgery (n = 3), and trauma (n = 1). Complete histopathologic assessment in 3 specimens showed signs consistent with pseudoexfoliation, without available history related to this condition in one of the cases. Moderate/severe degrees of Soemmering's ring formation and capsulorhexis phimosis were observed or reported in 13 and 11 specimens, respectively. Fourteen eyes were implanted and explanted by the same surgeon, with an interval of 92.7 ± 23.4 months between the procedures. His rate of explantation because of subluxation/dislocation was 0.76% of the CTRs implanted during the time considered. CONCLUSIONS: Explantation because of postoperative subluxation or dislocation of CTR-IOL-capsular bag complexes occurred approximately 6.8 years after implantation in this series, providing further evidence that a fine line exists between zonular insufficiency that can be stabilized with the CTR alone and that requiring further support. Analyses of large series may help to define common factors associated with this complication, as well as surgical planning and employment of various endocapsular support devices to enhance postoperative zonular stabilization.