Repositioning, IOL exchange result in similar outcomes for decentered, dislocated lenses

Repositioning using scleral suturing and iris suturing of IOLs and IOL exchange result in similar outcomes for lenses that have decentered or dislocated. Repositioning of the lenses can be associated with redislocation, and IOL exchange can be associated with retinal detachment and development of endophthalmitis. The preferred approach should be individualized to each patient by considering several factors, the most important of which are the material and position of the lens.

Key Points

Chicago-Repositioning using scleral suturing and iris suturing of IOLs and IOL exchange result in similar outcomes for lenses that have decentered or dislocated. Repositioning of the lenses can be associated with redislocation, and IOL exchange can be associated with retinal detachment and development of endophthalmitis, according to Joshua C. Teichman, MD, who spoke at the annual meeting of the American Society of Cataract and Refractive Surgery.

"IOL decentrations or dislocations occur in approximately 0.2% to 3% of cases," said Dr. Teichman, a research fellow in the Department of Ophthalmology and Vision Sciences, University of Toronto. "They can be out of the bag due to a complicated surgery or to asymmetric implantation at the time of the surgery. They also can be decentered or dislocated in the bag due to a number of etiologies and can occur early or late after the implantation procedure."

IOL decentrations and dislocation can be addressed with IOL repositioning with suture fixation to the sclera or the iris, IOL explantation with implantation of an anterior chamber IOL, an iris claw IOL, or a posterior chamber IOL with scleral or iris suturing, he said.

Dr. Teichman and colleagues conducted a retrospective study to compare the visual outcomes and complications after IOL exchange versus repositioning with sutures for IOLs that dislocated. The study included the charts of 219 patients who underwent IOL exchange (n = 122) or suture repositioning (n = 97) from 1995 to 2007. The patient groups had similar demographic characteristics.

"Decreased visual acuity was the most common symptom at the time of patient presentation," he said. "An anterior vitrectomy was the most commonly performed adjunctive procedure."

The difference between the best-corrected visual acuity (BCVA) preoperatively and postoperatively was not significant between the groups. The mean preoperative BCVA in the group in which the IOLs were repositioned improved from a preoperative level of 20/200 to a postoperative level of 20/70. The mean BCVA in the group in which IOL exchange was performed improved from 20/300 preoperatively to 20/80 postoperatively. Both of those differences reached significance (p < 0.00001 and p = 0.000000001, respectively), according to Dr. Teichman.

In the group of patients in which the IOLs were repositioned, dislocation was the most commonly occurring complication, happening in 5% of patients. In contrast, in the group in which IOL exchange was performed, two serious complications were present: retinal detachments (n = 2) and endophthalmitis (n = 1).

"IOL repositioning with suturing techniques or IOL explantation and exchange both provide a similar improvement in visual acuity," Dr. Teichman said. "The complications profiles between the two groups vary; however, the complication rate is low.

"Redislocation is the most common complication in the group of patients in which the IOL was repositioned. We observed serious complications, i.e., retinal detachment and endophthalmitis, in the group of patients who underwent IOL explantation. The preferred approach should be individualized to each patient and a number of factors considered, the most important of which is the position of the lens."