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Good visual outcomes not guaranteed after removing posterior dislocated IOLs
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WAILEA, Hawaii — A retinal surgeon said here that a review of literature shows it is best to remove the IOL in cases of posterior chamber IOL dislocations. However, surgeons should not always expect a good visual outcome.
At Hawaiian Eye 2009, Jay S. Duker, MD, framed the dilemma of what to do in posterior IOL dislocations using lyrics from the Clash song "Should I Stay or Should I Go."
"This basically summarizes the conclusion of my talk: 'If I go there will be trouble. If I stay it will be double,'" Dr. Duker said.
In a summary of the literature since 2000 on posterior IOL dislocations, removals were reported 50 times more than observation. Dr. Duker cautioned, however, that 20% of observed eyes had poor visual acuity and operated eyes still had poor visual acuity 10% to 17% of the time.
"The vast majority of posterior dislocated IOLs get removed, but remember, surgical intervention by a vitreoretinal specialist has a guarded prognosis," he said. "Only two-thirds will be 20/40 or better. CME occurs quite commonly, and the retinal detachment rate is 5%."
Dr. Duker said predisposing risk factors for posterior IOL dislocation are pseudoexfoliation and previous retinal surgery. Intraoperative risks are capsular tear and zonular dialysis. Postoperative risks include YAG capsulotomy and trauma.