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Late spontaneous in-the-bag IOL subluxation: a customized approach
Session Title: Subluxed IOLs and Scleral Fixation
Session Date/Time: Wednesday 09/10/2013 | 08:00-10:30
Paper Time: 09:01
Venue: E102 (First Floor)
First Author: : C.Pedrosa PORTUGAL
Co Author(s): : S. Pina C. Santos B. Feijoó P. Pźgo I. Prieto
The incidence of late spontaneous in-the-bag IOL subluxation has been increasing in recent years, despite the decreasing of most of other complications associated with cataract surgery. Bag dislocation occurs as a result of progressive zonular dehiscence many years after uneventful surgery. Several predisposing causes have been described such as pseudoexfoliation, uveitis, trauma, vitrectomy and increased axial length, preoperative zonular weakness, surgical trauma to the zonule, capsule contraction syndrome and postoperative trauma. The authors show in video different approaches for the management of this condition in order to be as minimally aggressive as possible, according to the situation.
Dept. of Ophthalmology, Fernando Fonseca Hospital, Lisbon, Portugal.
In our daily practice we reported, in the last 6 years, a series of 28 cases that presented late in-the-bag intraocular lens subluxation from 4 to 15 years after cataract surgery. Different presentations were observed including 5 cases with partial or total subluxation of the capsular bag in the anterior chamber and 2 with bilateral and simultaneous subluxation. Therapeutic options varied with the stage and site of the bag subluxation, IOL type, coexisting ocular pathologies, clinical progression, and presence of a capsular tension ring. In 2 patients we opted for a conservative approach. In 26 cases surgical approach included: repositioning of the dislocated IOL/bag complex with scleral suture in 6 eyes; and IOL/capsular bag complex extraction with implantation of iris-enclavated IOL in 20 eyes (2 with retropupilar implantation) with or without bimanual anterior 23G vitrectomy, In the majority of the cases a preserved free intracamerular injection of triamcinolone was used to identify the presence of vitreous and reduce postoperative inflammation. High density ocular viscosurgical device (OVD) was used to carefully detach the capsular bag avoiding vitreous traction and preserve the hyaloid membrane integrity.
No intra- or postoperative complications were registered except a re-dislocation in one of the cases with scleral suture that required reintervention to remove the IOL/capsular bag complex. All patients retrieved the visual acuity previous to the IOL-capsular bag complex dislocation.
As the incidence of late spontaneous in-the-bag IOL subluxation is increasing, discussion of therapeutic options becomes of great importance as surgical repair remains nonconsensual. In our series we obtained good visual and surgical outcomes. With a wide range of clinical presentations, the knowledge of the different surgical approaches with several surgical options and techniques allows us to costumize the treatment of these cases with low postoperative complications rate. Nevertheless a longer follow-up period is needed to further evaluate these options.