J Korean Ophthalmol Soc.  2012 Mar;53(3):420-427.

Clinical Outcomes of the Surgical Management with Dislocated Posterior Chamber Intraocular Lens

• Shin JH
• Lee JE
• Oum BS

Abstract

PURPOSE
To evaluate the clinical outcomes of the surgical treatment in patients with dislocation of an intraocular lens (IOL).
METHODS
The present study investigated the postoperative naked visual acuity, corrected visual acuity, astigmatism, and postoperative complications in patients with a minimum follow-up of 1 month after the surgical treatment of a dislocated posterior chamber IOL.
RESULTS
The study included 48 eyes of 48 patients (32 males and 16 females) with an age ranging from 33 to 76 years with a mean of 56.7 years at initial visit. The mean time interval from cataract extraction and IOL implantation to dislocation of IOL was 4.9 years. The IOL was exchanged in 13 eyes and was repositioned in 35 eyes. The IOL was repositioned without tying in 11 eyes, by scleral fixation with tying inside the eye in 10 eyes, and by scleral fixation with tying outside the eyeball in 14 eyes. The mean naked visual acuity improved from 1.21 +/- 0.70 to 0.70 +/- 0.48 (p = 0.001) and the best corrected visual acuity improved significantly from 0.82 +/- 0.68 to 0.35 +/- 0.30 (p = 0.002). Among the repositioned IOLs managed by IOL repositioning using scleral fixation with tying inside the eye, 4 eyes re-dislocated. These eyes were re-treated for a second time with IOL repositioning and scleral fixation with tying outside the eye.
CONCLUSIONS
Surgical management of dislocated IOLs resulted in significant improvement of visual acuity. Scleral fixation with tying inside the eye had a high risk of re-dislocation because of the difficulty in tightly securing the knot.

Keyword

Dislocated intraocular lens; Scleral fixation

MeSH Terms

Astigmatism
Cataract Extraction
Dislocations
Eye
Follow-Up Studies
Humans
Lenses, Intraocular
Male
Postoperative Complications
Visual Acuity

Figure

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  Figure 1 Scleral fixation with tying inside the eyeball. (A) The cow-hitch loop was made. (B) The loop was introduced via a sclerotomy with vitreous forceps. (C) The IOL haptic was engaged with the loop. (D) Scleral fixation was done with a 10-0 prolene after the IOL was positioned in the ciliary sulcus.

• 

  Figure 2 Scleral fixation with tying outside the eyeball. (A) The dislocated IOL is grasped with straight, vitreous forceps. (B) One haptic is externalized through a scleral insicion. (C) 10-0 Prolene double loop suture attached to a long curved needle is securely tightened around the externalized haptic. (D) The haptic with the tightened fixation suture is re-inplanted into position followed by scleral fixation with 10-0 prolene.

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