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Pathological evidence of pseudoexfoliation in cases of in-the-bag Intraocular lens subluxation/dislocation

Poster Details

First Author: T.Kohnen GERMANY

Co Author(s):    E. Liu   S. Cole   L. Werner   F. Hengerer   N. Mamalis  

Abstract Details


The incidence of late postoperative in-the-bag subluxation/dislocation of intraocular lenses (IOLs) has been rising since the development of the continuous curvilinear capsulorhexis, with or without the presence of a capsular tension ring (CTR). Pseudoexfoliation (PEX) is a significant associated condition in these cases, which can be clinically underdiagnosed. In this study we provide complete histopathological evaluation of explanted capsular bags that spontaneously dislocated in the late postoperative period, with the main objective to assess the presence of PEX material.


Dpt. of Ophthalmology, Goethe University, Frankfurt, Germany


Retrospective case series with histopathological examination.Forty specimens corresponding to explanted subluxated/dislocated capsular bags containing an IOL, or a CTR and an IOL; all explanted at the University of Frankfurt, Germany and submitted in fixative. Standard gross and light microscopy, and complete histopathological processing and analysis of all specimens done at the University of Utah, as well as questionnaire sent to explanting surgeons, and patient chart review, when available.


Lens design, material, capsular bag fibrosis, Soemmering’s ring (SR) formation, histopathological evidence of PEX material,&patient demographic data,and presence or absence of known risk factors. Specimens were represented by capsular bags containing an IOL (N = 37) or an IOL-CTR (N = 3). IOLs included 3-piece hydrophobic acrylic (N = 13), 1-piece hydrophobic acrylic (N = 7), 3-piece silicone (N = 6), 1-piece hydrophilic acrylic (N = 6), 3-piece hydrophilic acrylic (N = 2), and 1-piece PMMA (N = 6) designs; all CTRs were made of PMMA. 8 specimens exhibited mild SR; 18 exhibited moderate SR; 14 exhibited severe SR formation.


Excessive contraction of the capsular bag with capsulorhexis phimosis was observed in 24 specimens. 26 specimens had histopathological evidence of PEX, while only 13 had a clinical history/evidence of PEX. PEX may be implicated in a larger proportion of late in-the-bag IOL subluxations/dislocations than previously thought due to significant clinical under diagnosis, which was demonstrated in this study upon histopathological examination of 40 capsular bags containing an IOL or IOL-CTR. This may impart a need for new considerations during the pre- and postoperative cataract surgery assessments and follow-up.

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