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Late in-the-bag intraocular lens dislocation: a randomised trial comparing refractive outcomes and astigmatism after lens repositioning vs lens exchange

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Session Details

Session Title: Cataract Surgery Complications: IOL Dislocation and Opacification

Session Date/Time: Tuesday 10/10/2017 | 14:00-16:00

Paper Time: 14:00

Venue: Room 3.6

First Author: : O.Kristianslund NORWAY

Co Author(s): :    L. Drolsum                    

Abstract Details


Late in-the-bag intraocular lens (IOL) dislocation has become more frequent in recent decades. In principle, the dislocated IOL can be either repositioned or exchanged and the purpose of this randomised clinical trial was to compare refractive outcomes and surgically induced astigmatism (SIA) with these 2 operation methods.


Department of Ophthalmology, Oslo University Hospital, Norway (tertiary referral center). One surgeon (L.D.) performed all the operations.


In this prospective randomised clinical trial 104 patients with late in-the-bag IOL dislocation were randomly assigned to IOL repositioning by scleral suturing (n = 54) or IOL exchange with a 5.5-mm scleral pocket incision and retropupillar fixation of an iris-claw IOL (n = 50). Target refraction for IOL exchange was found with optical biometry using an A-constant of 116.9. Patients were examined with subjective refraction and Scheimpflug corneal topography before and 6 months after surgery. Surgically induced astigmatism was measured with vector analysis of corneal astigmatism. SIA values are presented as magnitude in diopters @ direction in degrees (D@°).


The 6-month postoperative spherical equivalent (SE) after IOL repositioning was -1.6±1.6 D, representing a myopic shift compared to SE before the IOL dislocation (P < 0.001). The postoperative SE after IOL exchange was -0.5±1.0 D, which was within ±1 D of target refraction in >80% of the patients. The corneal SIA was 0.24 D @ 8° after IOL repositioning and 0.65 D @ 171° after IOL exchange, with no significant difference between the operation groups in the magnitude of the vector components for SIA, neither in 90° (P = 0.06) nor in 135° (P = 0.11).


In these eyes operated for late in-the-bag IOL dislocation there was a modest SIA, which was not significantly different for IOL repositioning surgery compared to IOL exchange surgery. Intraocular lens repositioning resulted in a mean myopic shift, whereas IOL exchange with retropupillar fixation of an iris-claw IOL had good refractive predictability.

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