Glaucoma and Intraocular Pressure in Patients Operated for Late In-the-bag Intraocular Lens Dislocation: A Randomized Clinical Trial.
OBJECTIVE
To compare intraocular pressure (IOP) and IOP-lowering treatment requirements in patients with late in-the-bag intraocular lens (IOL) dislocation operated with 2 different methods, and to assess whether an IOP decrease after surgery can be expected.


METHODS
Prospective, randomized, parallel-group clinical trial.


METHODS
In our university clinic, 104 patients (eyes) were randomly assigned to IOL repositioning by scleral suturing (n = 54) or IOL exchange with a retropupillar iris-claw lens (n = 50). The main outcome measure was 6-month postoperative IOP change.


RESULTS
Overall IOP was 18.0 ± 6.2 mm Hg before surgery and 15.7 ± 4.8 mm Hg 6 months after surgery (P < .001). IOP changed by -1.2 ± 5.8 mm Hg (P = .18) in the Repositioning group and -3.8 ± 6.4 mm Hg (P < .001) in the Exchange group (group difference: P = .05). Before surgery, 62 patients had either preexisting glaucoma (n = 39) or high IOP (≥22 mm Hg) with suspected glaucoma (n = 23), of whom several required preoperative IOP-lowering treatment. In the postoperative period, 28% and 21% of the patients in each operation group, respectively, required IOP-lowering treatment with glaucoma medications added, adjunctive laser trabeculoplasty, cyclodiode laser, or filtering surgery. Only 0 and 3 patients, respectively, discontinued their IOP-lowering medication.


CONCLUSIONS
This trial showed an IOP decrease after late in-the-bag IOL dislocation surgery that seemed to be more pronounced with IOL exchange. However, associated high IOP was not resolved by dislocation surgery in many patients, and increased IOP-lowering treatment in the postoperative course was commonly required.
Department of Ophthalmology, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway. Electronic address: olav.kristianslund@gmail.com.
Olav
O
Kristianslund
Department of Ophthalmology, Oslo University Hospital, Oslo, Norway.
Marianne
M
Råen
Department of Ophthalmology, Oslo University Hospital, Oslo, Norway.
Atle Einar
AE
Østern
Department of Ophthalmology, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
Liv
L
Drolsum
D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D005902:Glaucoma, Open-Angle / Q000209:etiology* / Q000503:physiopathology / Q000601:surgery; D006801:Humans; D007429:Intraocular Pressure / Q000502:physiology*; D007906:Lens Subluxation / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D007910:Lenses, Intraocular / Q000009:adverse effects*; D008297:Male; D018918:Phacoemulsification / Q000379:methods*; D011446:Prospective Studies; D014130:Trabeculectomy / Q000379:methods*; D016896:Treatment Outcome; D014792:Visual Acuity