title: Epidemiology, Etiology, and Prevention of Late IOL-Capsular Bag Complex Dislocation: Review of the Literature.
abstract: Posterior chamber intraocular lens (PC-IOL) subluxation is uncommon but represents one of the most serious complications following phacoemulsification. Late spontaneous IOL-capsular bag complex dislocation is defined as occurring three months or later following cataract surgery. Unlike early IOL dislocation, late spontaneous IOL dislocation is due to a progressive zonular dehiscence and contraction of the capsular bag many years what seemed to be uneventful surgery. In recent years, late in-the-bag IOL subluxation or dislocation has been reported with increasing frequency, having a cumulative risk of IOL dislocation following cataract extraction of 0.1% after 10 years and 1.7% after 25 years. A predisposition to zonular insufficiency and capsular contraction is identified in 90% of reviewed cases. Multiple conditions likely play a role in contributing to this zonular weakness and capsular contraction. Pseudoexfoliation is the most common risk factor, accounting for more than 50% of cases. Other associated conditions predisposing to zonular dehiscence are aging, high myopia, uveitis, trauma, previous vitreoretinal surgery, retinitis pigmentosa, diabetes mellitus, atopic dermatitis, previous acute angle-closure glaucoma attack, and connective tissue disorders. The recognition of these predisposing factors suggests a modified approach in cases at risk. We review certain measures to prevent IOL-bag complex luxation that have been proposed.
authors.affiliation: Department of Ophthalmology, University Clinic Hospital Lozano Blesa, Avenida San Juan Bosco 15, 50009 Zaragoza, Spain; Aragon Institute of Health Research (IIS Aragón), Avenida San Juan Bosco 13, 50009 Zaragoza, Spain.
authors.forename: Francisco J
authors.initials: FJ
authors.lastname: Ascaso
authors.affiliation: Department of Ophthalmology, University Hospital Arnau de Vilanova, Avenida Rovira Roure 80, 25198 Lleida, Spain; IRB Lleida, Avenida Rovira Roure 80, 25198 Lleida, Spain.
authors.forename: Valentín
authors.initials: V
authors.lastname: Huerva
authors.affiliation: Department of Ophthalmology, Poznan City Hospital, Ulica Szwajcarska 3, 61-285 Poznan, Poland; Department of Ophthalmology, University of Warmia and Mazury, 10-982 Olsztyn, Poland.
authors.forename: Andrzej
authors.initials: A
authors.lastname: Grzybowski