title: Management of late spontaneous in-the-bag intraocular lens dislocation: Retrospective analysis of 45 cases.
abstract: OBJECTIVE
  To evaluate the characteristics of and risk factors for spontaneous late in-the-bag intraocular lens (IOL) dislocation and to analyze the outcomes of surgical correction.
  
  
  METHODS
  Department of Ophthalmology, Complejo Hospitalario Orense, Orense, Spain.
  
  
  METHODS
  In this retrospective single-surgeon interventional case series, the surgical database of a referral center was searched for cases of late spontaneous in-the-bag IOL dislocation between 2005 and 2009. The main outcome measures were interval between surgery and dislocation, dislocation site and grade, IOL type, associated capsular tension ring (CTR), predisposing factors, surgical technique to correct dislocation, preoperative and postoperative corrected distance visual acuity (CDVA), and surgical complications.
  
  
  RESULTS
  Pseudoexfoliation was the main risk factor for in-the-bag IOL dislocation (66.66% of 45 cases identified). A CTR was present in the capsular bag in 8 cases. Dislocation was corrected by repositioning using scleral fixation (20 cases) or iris suturing (1 case), IOL exchange for an anterior chamber IOL (AC IOL) (19 cases) or iris-claw IOL (4 cases), or (3) anterior capsulotomy (1 case). The mean CDVA improved significantly postoperatively (P = .0001); it was 20/40 or better in 28 eyes (62.22%) and 20/25 or better in 10 eyes (22.22%). There was no significant difference in postoperative CDVA between scleral-fixated IOLs and AC IOLs (P = .316).
  
  
  CONCLUSIONS
  Pseudoexfoliation was the main risk factor for in-the-bag IOL dislocation. The presence of a CTR in the bag did not prevent dislocation. Satisfactory results were achieved with a low rate of complications using different surgical techniques to correct IOL position.
  
  
  BACKGROUND
  No author has a financial or proprietary interest in any material or method mentioned.
authors.affiliation: Department of Ophthalmology, Complejo Hospitalario Orense, Spain.
authors.forename: Ramón
authors.initials: R
authors.lastname: Lorente
authors.forename: Victoria
authors.initials: V
authors.lastname: de Rojas
authors.forename: Paula
authors.initials: P
authors.lastname: Vazquez de Parga
authors.forename: Claudio
authors.initials: C
authors.lastname: Moreno
authors.forename: M Luisa
authors.initials: ML
authors.lastname: Landaluce
authors.forename: Ramón
authors.initials: R
authors.lastname: Domínguez
authors.forename: Betty
authors.initials: B
authors.lastname: Lorente
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017889:Exfoliation Syndrome / Q000150:complications; D005260:Female; D006801:Humans; D007903:Lens Capsule, Crystalline / Q000601:surgery; D007910:Lenses, Intraocular; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011475:Prosthesis Failure; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D014792:Visual Acuity / Q000502:physiology