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IntraocularLensDislocationFollowup
Updated:Sep29,2015
Author:LihtehWu,MDChiefEditor:HamptonRoy,Sr,MDmore...
FOLLOWUP
FurtherOutpatientCare
Patientsshouldreceivefollowupcareasneeded.
Deterrence/Prevention
AstudybyTappinetalexaminedsomeoftheintraoperativeandpostoperativefactorsleadingto
IOLdecentrationinpatientsrequiringIOLexchangeinanattempttoidentifyavoidablecausesof
IOLdecentration.[8]Theyconcludedthatsignificantpostoperativesubluxationofinjectedsilicone
IOLsmaybeminimizedbyimplantingonlyintoalenscapsulebagwithanintactcapsulorrhexis.
Theriskofdecentrationofasmalloptic(5.5mm)PMMAIOLmaybeminimizedbypositioningthe
hapticsat90toanycapsulorrhexistear.Aftercataractsurgerycomplicatedbyposteriorcapsular
ruptureorzonulardehiscence,itisimportanttoassesstheremainingcapsularsupportand,if
sufficient,implantalargeopticdiameter(7mm)PCLintheciliarysulcus.
Theanteriorsegmentsurgeonshouldbeadvisedtoavoidimplantationofaflexiblesiliconeplate
IOLifthereisabreakintheposteriorcapsule,radialnotch,ortearintheanteriorcapsularrimor
zonulardialysis.
Smallcapsulorrhexisopeningsshouldbeavoided.
CurrentmodelsofACIOLsoftendonotresultinthesametypesofcomplicationsasoldermodels.
Theselensesshouldbeconsideredifadequatecapsularsupportislackingratherthanriskinga
posteriordislocationofanIOL.
Complications
ComplicationsfromadecenteredIOL
ComplicationsassociatedwithACIOL,irisfixatedIOLs,andolderPCIOLsaremuchmoresevere
thanthoseencounteredwithmodernPCIOLdecentration.Cornealedemaandinflammatory
consequencessuchasuveitisglaucomahyphemasyndromeandchronicCMEwerecommon
reasonsforexplanationintheabovecases.
ComplicationsfromadislocatedIOL
ComplicationsassociatedwithdislocatedIOLincludethefollowing:
Vitreoushemorrhage
Retinaldetachmenthasbeenestimatedtooccurinatleast2%ofcases.Itfrequentlyis
causedbyattemptsatrelocationbythecataractsurgeonorasacomplicationofvitreoretinal
surgery.
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Cystoidmacularedema
Uncorrectedaphakia,glare,ordistortion
Complicationsfromtransscleralsuturefixation
Lateendophthalmitisthroughthesuturetrackhasbeenreported.
IOLtorquemayoccur.Inaddition,toplacetheIOLtrulyinthesulcus,thesuturemustbeplaced
0.8mmposteriortothelimbusintheverticalmeridianand0.46mminthehorizontalmeridian.The
effectivelenspowerisprobablylessthanthedesiredone.
Vitreoushemorrhagemayoccurifthemajorarterialcircleoftheirisispiercedinadvertentlyduring
themaneuversrequiredtosuturetheIOL.Inaddition,thesemaneuversalsomayraisetheriskof
apostoperativeretinaldetachment.
Erosionofthesuturethroughtheconjunctivaalsohasbeenreportedincaseswherescleralflaps
wereused.Anattempttomelttheerodedsutureswiththeargonlaserhasbeenrecommended.
ThesuturescannotberemovedbecausetheIOLhapticsdonotscarintoplaceifplacedinthe
ciliarysulcus.Oncethesuturesareremoved,theIOLwillredislocate.
Prognosis
Withpropervitreoretinaltechniques,excellentvisualresultsandalowcomplicationrateis
possible.Longtermprognosisishighlydependentonthepreventionofretinaldetachmentand
choroidalhemorrhagesecondarytosurgicalmanipulation.
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ContributorInformationandDisclosures
Author
LihtehWu,MDOphthalmologist,CostaRicaVitreoandRetinaMacularAssociates
LihtehWu,MDisamemberofthefollowingmedicalsocieties:AmericanAcademyof
Ophthalmology,AmericanSocietyofRetinaSpecialists,AssociationforResearchinVisionand
Ophthalmology,ClubJulesGonin,MaculaSociety,PanAmericanAssociationofOphthalmology,
RetinaSociety
Disclosure:Receivedincomeinanamountequaltoorgreaterthan$250from:BayerHealth
QuantelMedicalHeidelbergEngineeringNovartis.
Coauthor(s)
RafaelAlbertoGarca,MD
Disclosure:Nothingtodisclose.
RobertHGraham,MDConsultant,DepartmentofOphthalmology,MayoClinic,Scottsdale,
Arizona
RobertHGraham,MDisamemberofthefollowingmedicalsocieties:AmericanAcademyof
Ophthalmology,ArizonaOphthalmologicalSociety,AmericanMedicalAssociation
Disclosure:PartnerreceivedsalaryfromMedscape/WebMDforemployment.
SpecialtyEditorBoard
http://emedicine.medscape.com/article/1211310followup 5/6
3/13/2017 IntraocularLensDislocationFollowup:FurtherOutpatientCare,Deterrence/Prevention,Complications
SimonKLaw,MD,PharmDClinicalProfessorofHealthSciences,DepartmentofOphthalmology,
JulesSteinEyeInstitute,UniversityofCalifornia,LosAngeles,DavidGeffenSchoolofMedicine
SimonKLaw,MD,PharmDisamemberofthefollowingmedicalsocieties:AmericanAcademyof
Ophthalmology,AssociationforResearchinVisionandOphthalmology,AmericanGlaucoma
Society
Disclosure:Nothingtodisclose.
SteveCharles,MDDirectorofCharlesRetinaInstituteClinicalProfessor,Departmentof
Ophthalmology,UniversityofTennesseeCollegeofMedicine
SteveCharles,MDisamemberofthefollowingmedicalsocieties:AmericanAcademyof
Ophthalmology,AmericanSocietyofRetinaSpecialists,MaculaSociety,RetinaSociety,Club
JulesGonin
Disclosure:Receivedroyaltyandconsultingfeesfor:AlconLaboratories.
ChiefEditor
HamptonRoy,Sr,MDAssociateClinicalProfessor,DepartmentofOphthalmology,Universityof
ArkansasforMedicalSciences
HamptonRoy,Sr,MDisamemberofthefollowingmedicalsocieties:AmericanAcademyof
Ophthalmology,AmericanCollegeofSurgeons,PanAmericanAssociationofOphthalmology
Disclosure:Nothingtodisclose.
AdditionalContributors
BrianAPhillpotts,MD,MD
BrianAPhillpotts,MD,MDisamemberofthefollowingmedicalsocieties:AmericanAcademyof
Ophthalmology,AmericanDiabetesAssociation,AmericanMedicalAssociation,NationalMedical
Association
Disclosure:Nothingtodisclose.
Acknowledgements
TeodoroEvans,MDConsultingSurgeon,VitreoRetinalSection,ClinicadeOjos,CostaRica
Disclosure:Nothingtodisclose.
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