Risk factors for IOL dislocations and displacement and their surgical treatment outcomes
First Author: E.Samia-Aly UK
Co Author(s): G. Moussa S. Ch'ng
To evaluate the risk factors and possible comorbidities, and outcomes in patients that suffered from an IOL dislocation or displacement.
All patients who underwent surgery to correct a dislocated or displaced IOL at a tertiary UK eye hospital were included in this study.
A search was performed of all electronic patient surgical operation notes between 2015 to 2019 identifying any patients that required secondary vitreoretinal surgical treatment for IOL dislocations or displacement. 72 patients were identified to have had surgery for displaced or dislocated IOLs in the same hospital. These included patients who had dislocations or displacement during surgery, due to other ophthalmic comorbidities, and patients who experienced problems years following cataract surgery. Time from presentation to initial surgery had two peaks with one peak at 21 days on average, and the second at 22.7 years. The overall mean was 13 years.
All 72 patients underwent pars planar vitrectomy with, 19(26%) scleral fixated IOL, 17(24%) ACIOL, 11 (15%) left aphakic, 9 (13%) Artisan, and 5(7%) IOL repositioning. The most common comorbidities included previous retinal detachment repair 14(19%), glaucoma 11(15%) and myopia 6(8%). At original surgery, 15(21%) had posterior capsular rupture (PCR), and 3(4%) zonular dialysis. Mean VA presentation vs discharge was LogMar1.03 vs 0.7 (p=0.001). IOLs removed from vitreous had significantly better improvement in mean Logmar VA compared to subluxed IOL (0.8 vs 0.25, p = 0.025). There was no significant difference in VA with type of secondary lens used (p=0.183, chi-squared).
Overall the majority of patients that end up with IOL dislocations or displacements that required surgical correction are those who have undergone complicated cataract surgery. Those that then had surgery where the IOLs were removed from the vitreous had the best visual outcomes. Given almost 19000 cataracts were performed in the study period in this hospital alone, the percentage needing surgical correction for any IOL issues are very small.