Late In-the-Bag IOL Dislocation in Patients With Uveitis
Late In-the-Bag IOL Dislocation in Patients With Uveitis
Background Late in-the-bag intraocular lens (IOL) dislocation is an unusual complication of cataract surgery, being strongly associated with pseudoexfoliation, less so with previous vitreoretinal surgery, myopia and uveitis. We present the clinical features, management and outcomes of late spontaneous IOL dislocation in a series of patients with uveitis.
Methods A retrospective case series of IOL dislocation affecting patients in the Manchester Uveitis Clinic, UK. The uveitis diagnosis, IOL type, presentation and management are discussed.
Results Six patients from out of 1056 undergoing cataract surgery (0.57%) were affected. Uveitis was the only identified risk factor for IOL dislocation, which occurred a mean 10.3 years following uncomplicated cataract surgery by phakoemulsification with endocapsular IOL implantation. The dislocation was in-the-bag in all six cases. Two patients presented with the IOL in the anterior chamber, and required removal of the IOL-bag complex, and are using aphakic refractive correction. Two patients with inferior IOL subluxation have been managed conservatively. Two patients underwent pars plana vitrectomy with sutureless scleral fixation of the existing IOL in one case, and IOL exchange with a scleral sutured IOL in the other.
Conclusions IOL dislocation is an uncommon late complication in patients with uveitis. Conservative management is appropriate in patients with tolerable symptoms, or in those with difficult uveitis. Otherwise, fixation of the existing IOL, or removal and implantation of a secondary IOL, may be necessary. Angle-supported, or iris-enclaved IOLs, are not of proven safety in this patient group; scleral-fixated posterior chamber IOLs are the favoured approach in our service.
Intraocular lens (IOL) subluxation, or dislocation within the capsular bag ('in-the-bag' IOL dislocation), is an uncommon but potentially serious complication after cataract surgery. A predisposition to zonular dehiscence and capsular contraction is identified in the great majority of cases, pseudoexfoliation being the most common risk factor.
Others include axial myopia, previous vitreoretinal surgery, uveitis, trauma, and retinitis pigmentosa. Recent published series of IOL dislocations have included small numbers of uveitis cases. However, a previous study of cataract surgery in patients with uveitis emanating from this clinic with postoperative follow-up of greater than 7 years identified no cases of IOL dislocation. This study describes, for the first time, a series of patients with chronic uveitis and late IOL dislocation, and describes management techniques and outcomes.
Abstract and Introduction
Abstract
Background Late in-the-bag intraocular lens (IOL) dislocation is an unusual complication of cataract surgery, being strongly associated with pseudoexfoliation, less so with previous vitreoretinal surgery, myopia and uveitis. We present the clinical features, management and outcomes of late spontaneous IOL dislocation in a series of patients with uveitis.
Methods A retrospective case series of IOL dislocation affecting patients in the Manchester Uveitis Clinic, UK. The uveitis diagnosis, IOL type, presentation and management are discussed.
Results Six patients from out of 1056 undergoing cataract surgery (0.57%) were affected. Uveitis was the only identified risk factor for IOL dislocation, which occurred a mean 10.3 years following uncomplicated cataract surgery by phakoemulsification with endocapsular IOL implantation. The dislocation was in-the-bag in all six cases. Two patients presented with the IOL in the anterior chamber, and required removal of the IOL-bag complex, and are using aphakic refractive correction. Two patients with inferior IOL subluxation have been managed conservatively. Two patients underwent pars plana vitrectomy with sutureless scleral fixation of the existing IOL in one case, and IOL exchange with a scleral sutured IOL in the other.
Conclusions IOL dislocation is an uncommon late complication in patients with uveitis. Conservative management is appropriate in patients with tolerable symptoms, or in those with difficult uveitis. Otherwise, fixation of the existing IOL, or removal and implantation of a secondary IOL, may be necessary. Angle-supported, or iris-enclaved IOLs, are not of proven safety in this patient group; scleral-fixated posterior chamber IOLs are the favoured approach in our service.
Introduction
Intraocular lens (IOL) subluxation, or dislocation within the capsular bag ('in-the-bag' IOL dislocation), is an uncommon but potentially serious complication after cataract surgery. A predisposition to zonular dehiscence and capsular contraction is identified in the great majority of cases, pseudoexfoliation being the most common risk factor.
Others include axial myopia, previous vitreoretinal surgery, uveitis, trauma, and retinitis pigmentosa. Recent published series of IOL dislocations have included small numbers of uveitis cases. However, a previous study of cataract surgery in patients with uveitis emanating from this clinic with postoperative follow-up of greater than 7 years identified no cases of IOL dislocation. This study describes, for the first time, a series of patients with chronic uveitis and late IOL dislocation, and describes management techniques and outcomes.
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