Capsular Bag Defect And The Subluxated Intraocular Lens In Eyes With Dead Bag Syndrome

To describe the characteristics of the subluxated intraocular lens (IOL) and the capsular bag defect in eyes with dead bag syndrome

Singapore National Eye Centre (SNEC), Singapore

Retrospective consecutive case series of out-of-the-bag IOL dislocation with dead bag syndrome managed by a single surgeon. Patient demographics, clinical findings of the IOL model and placement; capsule rip location, origin and meridian; and size and location of posterior capsule (PC) defect were studied. The PC rip meridian was categorized into horizontal (0 or 180 ± 30 degrees), vertical (90 or 270 ± 30 degrees), and oblique when between. The location of the center of the rip at the equator of the capsular bag was approximated to superior, temporal, inferior or nasal (± 45 degrees). Comparison of IOL type was made with an audit sample of cataract surgeries in SNEC in 2017.

50 eyes of 45 patients studied. Mean PC defect size was 53.8%, located nasally in 25 eyes.  The rip in 16 eyes was equatorial, 34 eyes across the PC. Equatorial rips were nasal in 13 eyes (50%) and coincided with previous haptic location. 15 eyes had a single piece square edged hydrophobic acrylic IOL (SPSEHA). Of PC rips, the IOL was attached to the bag in 27 eyes. 20 eyes had obliquely nasal rip coinciding with the edge of the optic: 14 SPSEHA, 7 3-piece square edged hydrophobic acrylic, 6 others. IOLs were vertical or obliquely aligned. Another 7 IOLs, all SPSEHA, were in the vitreous. 39 IOLs (78%) had square anterior/posterior edge was significantly more than the proportion implanted in SNEC (57%) 2017 (p=0.003, Fisher's Exact Test).

The capsular bag rip across the PC or at the equator in dead bag syndrome with out-of-the-bag IOL dislocation may be related to the square edge of the optic or haptic respectively. Eye rubbing may account for the predominantly nasal location of these rips.