Dead Bag Syndrome, Late Intraocular Lens Implant Dislocation And Glaucoma- Clinical, Histopathological Findings And Management Options

To report the clinical and histopathological findings in a case series of patients with the dead bag syndrome, late intraocular lens (IOL) dislocation along with glaucoma and discuss management options.

Retrospective case series

A retrospective analysis was done of eyes that developed IOL dislocation and were found to have the dead bag syndrome. Only cases with history of uneventful cataract surgery were included. Eyes with raised intraocular pressure or those on anti-glaucoma treatment were included. Eyes with complicated cataract surgery, history of trauma or any retina pathologies were excluded.

 Twelve eyes of 11 patients (age range  52- 75 years) (all males) were included in this study. Ten eyes reported IOL dislocation after 6 -10 years of uneventful cataract surgery (83.3%). No predisposing factors were noted. In 2 eyes the IOL was subluxated inferonasally, in 2 eyes it was in the anterior chamber and in the rest, in the posterior vitreous. The dislocated IOL was replaced by scleral fixated IOL (SFIOL) with Goretex suture in 10 eyes and in 2 eyes the same IOL was refixed to the sclera. Raised IOP with open angles were noted in 5 eyes, three were controlled medically and two underwent trabeculectomy. Final visual acuity of ≥20/30 was achieved in 7 cases. Histopathology of the explanted IOLs showed dead, acellular capsule.

Dead bag syndrome can be associated with weak zonules and lead to late in the bag IOL dislocation. Open angle glaucoma can be associated with dead bag syndrome. Vitrectomy and exchanging the dislocated IOL for a SFIOL was not enough to control the IOP and additional management in form of trabeculectomy or anti-glaucoma medication is required.ter