Late in-the-bag spontaneous intraocular lens dislocation: evaluation of 86 consecutive cases.
OBJECTIVE
As techniques for cataract surgery have evolved, spontaneous intraocular lens (IOL) dislocation has decreased overall. However, since 2006 the Intermountain Ocular Research Center has received an increased number of explanted IOLs within the capsular bag forwarded for pathologic evaluation. Late, spontaneous dislocation of IOLs results from zonular insufficiency and zonulysis that has been associated with pseudoexfoliation, trauma, and other risk factors. The findings of 86 consecutive cases of this complication, analyzed in the laboratory, are described.


METHODS
Retrospective case series.


METHODS
Eighty-six IOLs explanted within the capsular bag, submitted in formalin.


METHODS
Standard light microscopy of specimens, as well as questionnaire sent to explanting surgeons and patient chart review, when available.


METHODS
Lens design, material, and abnormalities; capsular bag anomalies; patient demographic data; surgical dates; and presence or absence of known risk factors.


RESULTS
This series included polymethyl methacrylate, silicone, and hydrophobic acrylic lenses, manufactured with both 1-piece and 3-piece designs. The mean time from surgery to spontaneous IOL dislocation was 8.5 years. The main conditions associated with the cases of IOL dislocation were as follows: pseudoexfoliation, 50%; prior vitreoretinal surgery, 19%; history of trauma, 6%; uveitis, 2%; and none or unknown, 23%.


CONCLUSIONS
Patients with any type of IOL are at risk for late in-the-bag dislocation. Pseudoexfoliation and vitreoretinal surgery were the most common associated conditions in this series. Regardless of the presence of known risk factors, IOLs dislocated on average 8.5 years after phacoemulsification and IOL implantation.
Davis
Don
D
John A. Moran Eye Center, University of Utah, Salt Lake City, Utah 84132, USA.
Brubaker
Jacob
J
Espandar
Ladan
L
Stringham
Jack
J
Crandall
Alan
A
Werner
Liliana
L
Mamalis
Nick
N
D000180:Acrylic Resins; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017889:Exfoliation Syndrome / Q000150:complications; D005260:Female; D005548:Foreign-Body Migration / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D006801:Humans; D007903:Lens Capsule, Crystalline / Q000601:surgery*; D019654:Lens Implantation, Intraocular; D007910:Lenses, Intraocular; D008297:Male; D008875:Middle Aged; D018918:Phacoemulsification; D019904:Polymethyl Methacrylate; D011183:Postoperative Complications; D011474:Prosthesis Design; D012160:Retina / Q000601:surgery; D012189:Retrospective Studies; D012307:Risk Factors; D012826:Silicone Elastomers; D011795:Surveys and Questionnaires; D013997:Time Factors; D014821:Vitrectomy
D000180:Acrylic Resins; D012826:Silicone Elastomers; D019904:Polymethyl Methacrylate