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An Epidemic of Dislocated IOLs?

An Epidemic of Dislocated IOLs?. Garth Stevens Jr. MD Eye Care Center of Virginia Mary Washington Eye Care Center. Financial Disclosure. The speaker is a paid consultant to Allergan, Inspire, and Abbott Medical Optics. Observation. Increased incidence of IOL dislocation the last 5 years.

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An Epidemic of Dislocated IOLs?

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  1. An Epidemic of Dislocated IOLs? Garth Stevens Jr. MD Eye Care Center of Virginia Mary Washington Eye Care Center

  2. Financial Disclosure The speaker is a paid consultant to Allergan, Inspire, and Abbott Medical Optics

  3. Observation • Increased incidence of IOL dislocation the last 5 years

  4. Incidence over time • Retina Institute of Virginia (379.39,996.53) • 2006: 12 • 2007: 17 • 2008: 23 • 2009: 22 • 2010: 23 • Eye Care Center of Virginia • 2000 to 2006: 14 • 2007: 12 • 2008: 15 • 2009: 18 • 2010: 15

  5. Question: is there an increased incidence of dislocated IOLs over the last decade? • Davis et al Ophthalmology 2009, 116, 664-670. • 86 cases in bag pathology specimens • 2000-2006: 27 • 2006-2008: 59 • Associated diagnosis • Pseudoexfoliation (PXF) 50% • Vitreo-retinal surgery 19% • Trauma 16% • Unknown 23% • Uveitis 2%

  6. Incidence of IOL dislocation • Unclear, older reports from 1980s 0.2 to 3%, no good recent data. Certainly less than 1% with modern cataract surgery techniques • Clark .2% 10 y period others 0.6% over 10 y, with 2% with phakodonesis • How many of you have experienced in the bag dislocations, out of bag dislocations??

  7. Role of capsular phimosis • Mechanisms • Preop zonules weak, surgery, capsular contraction, post op trauma • Exerts traction on zonules and may be related to dislocations • Should we avoid small capsulorhexis in high risk patients?

  8. Capsular phimosis as a cause of dislocation

  9. Open questions • Do capsular tension rings decrease the incidence of late dislocation of IOLs in PXF? • Probably yes with the Cionni ring and scleral fixation • Should we ensure that capsulotomy openings are larger in PXF to avoid capsular contraction syndrome?

  10. Cofactors in Dislocations EARLY LATE Pseudo-exfoliation Vitreoretinal surgery Trauma Uveitis Cataract surgery complications Yag capsulotomy Capsular contraction syndrome • Capsular rupture • Capsular instability

  11. Dislocated with attached capsule Courtesy J. Astruc

  12. Iris sutured IOL 10-0 prolene

  13. Primary treatment concerns • When to intervene • Pseudo-phakodonesis • Subluxation • Dislocation • Factors • Age

  14. Surgical decisions • Replace or reposition • Replace • Damaged haptic • Opacified optic • One piece PMMA IOL with suturing eyelets in haptics • Scleral fixation with prolene or Gore-Tex sutures • Alternative • AC IOL • In bag suturing to sclera or iris • Fibrin glue to haptics under sclera

  15. 90 y o, 20 y after cataract surgery, 3 y after suturing of left eye, 20/400 preop, 20/40 post op, removal retained lens material

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