Managing Late In-The-Bag Iol Subluxations: A Decade-Long Review Of Surgical Outcomes

To evaluate the outcomes and safety of different surgical approaches for late in-the-bag intraocular lens (IOL) subluxation.

Department of Ophthalmology, Hospital Prof. Doutor Fernando Fonseca, Lisbon, Portugal.

This retrospective study reviewed 76 eyes with late in-the-bag IOL subluxation between 2013 and 2024. We analyzed predisposing factors, the interval between cataract surgery and subluxation, best-corrected visual acuity (BCVA), and refractive status at baseline, 1, 6, and 12 months postoperatively. Surgical techniques included IOL exchange with iris-claw implantation and repositioning with scleral suspension, assessing outcomes and complications.

Pseudoexfoliation was the most frequent cause (52.6%), followed by trauma (19.5%). The mean age was 78.6 ± 11.2 years, with an interval of 8.63 ± 2.4 years after cataract surgery. IOL exchange was performed in 88.72% of cases (73.7% pre-pupillary vs. 26.3% retro-pupillary), and scleral suspension techniques were used in 11.8% of cases, which will all be demonstrated in videos. Mean BCVA at 1 year was 0.72 for repositioning and 0.76 for IOL exchange (p-value=0.421). Pre-pupillary placement had a mean BCVA of 0.8 vs. 0.68 for retro-pupillary(p-value=0.610). Retinal detachment and cystoid macular edema occurred in 2 cases each. Transient ocular hypertension was observed in 9 cases.

In the last decade, various techniques have emerged for managing late IOL subluxations, with no clear superiority among them. Different types of subluxation require tailored approaches. In our experience, IOL explantation with iris-claw implantation was most frequently used due to the high prevalence of PSX and crowded capsular-IOL complexes with Soemmering's ring. All techniques provided similar visual outcomes, emphasizing the need for individualized surgical planning.