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Case series finds increasing incidence of in-the-bag IOL dislocations
Ophthalmology. 2008;115(10):1699-1704.
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A retrospective case review revealed that one-quarter of IOL dislocations occurred within the first 24 hours after implantation, but the majority of dislocations occurred after 1 month.
In a noncomparative analysis of 284 dislocations in 277 eyes followed by a single surgeon, IOL dislocation occurred in 177 eyes (62%) after 1 month, including 126 occurrences (44%) after 1 year.
There were 113 dislocations with PMMA IOLs, 70 with acrylic IOLs, 51 with silicone plate haptic IOLs, 38 with three-piece IOLs, nine with anterior chamber IOLs and three with iris-supported IOLs.
In-the-bag dislocations occurred in 51 eyes (18%). Median time to in-the-bag dislocation was 6.8 years (range, 1 day to 16 years) compared with 62 days (range, 0 days to 24 years) for other types of dislocations. In addition, the incidence of in-the-bag IOL dislocation increased over time. About 77% of in-the-bag dislocations occurred in the second half of the series (1999 to 2007) and about 24% in the first half (1989 to 1998).
A variety of management strategies were employed for correcting the dislocated IOL and depended on the patient's pathology and case specifics.
"This, the largest retrospective study of management of dislocated IOLs, reports good outcomes with the variety of established management techniques, even for the now more common foldable IOLs, with acceptably low complication rates," the study authors said. "The frequency of in-the-bag dislocations seems to be increasing, and requires either scleral suture fixation or IOL exchange techniques."