Dislocated Lens And Aphakia Management Via Pars Plana Vitrectomy

To evaluate outcomes of IOL exchange or repositioning for dislocated lenses, and secondary IOL implantation in aphakic eyes, using a pars plana vitrectomy approach.

Eye Hospital, University Medical Center Ljubljana, Ljubljana, Slovenia

This retrospective, consecutive, single-center case series included 51 eyes of 51 patients, all operated by a single surgeon. All eyes underwent pars plana vitrectomy. Of these, 30 eyes had scleral-fixated IOL exchange, 5 had sulcus implantation due to adequate capsular support, 5 had lensectomy with scleral-fixated IOL, and 11 aphakic eyes underwent secondary scleral-fixated IOL implantation. Pre- and postoperative best corrected visual acuity (BCVA), uncorrected visual acuity (UCVA), intraocular pressure (IOP), postoperative IOL centration, and intra- and postoperative complications were assessed.

Fifty-one eyes of 51 patients (36 male, 15 female; median age 68, range 43–90) were analyzed. Forty had lens dislocation (35 IOLs) and 11 were aphakic. Comorbidities included glaucoma (15), ocular trauma (15), and prior pars plana vitrectomy (14). Mean UCVA improved significantly from 0.067±0.02 (logMAR 1.16) to 0.4±0.03 (logMAR 0.4) at final follow-up (P<0.001). Mean postoperative BCVA was 0.6±0.04 (logMAR 0.22). IOP remained stable and IOL centration was satisfactory in nearly all eyes. Complications were infrequent and manageable: optic capture (2), anterior nodular scleritis (1), hemophthalmos with hypotony (1), and corneal endothelial decompensation (1). Overall outcomes were favorable.

Management of dislocated lenses and aphakia using pars plana vitrectomy combined with scleral fixation or sulcus implantation is safe and effective, achieving good postoperative IOL centration, improved visual acuity, and favorable refractive outcomes.