Study shows low rates of IOL decentration, pseudophakodonesis at 10 years postop

Ophthalmology. 2009;116(12):2315-2320.

The incidence of posterior chamber IOL dislocation and excessive IOL movement was low 10 years after cataract surgery, according to a study.

"The potential burden to society caused by dislocated IOLs is relatively large, however, because of the large number of people undergoing cataract surgery," the study author said.

The prospective population-based study included a cohort of 810 patients who underwent cataract surgery and IOL implantation between June 1997 and May 1998. Mean patient age was 74.7 years.

Ninety-eight percent of patients underwent sutureless clear corneal phacoemulsification through a 3.2-mm temporal incision. Ninety-five percent of patients received a three-piece hydrophobic foldable IOL (AcrySof MA60BM, Alcon). Eleven patients who underwent sutureless clear corneal phacoemulsification also received capsular tension rings. About 40% of patients had pseudoexfoliation syndrome.

At 10 years after surgery, 289 of 395 surviving patients underwent full ocular examinations. Investigators gauged IOL dislocation, decentration and pseudophakodonesis. They also studied the records of deceased or nonparticipating patients to discern who had undergone IOL exchange or repositioning surgery in the years after implantation.

Study data showed that at 10 years, of 800 patients deemed at risk for dislocation, five patients (0.6%) had IOL dislocation that required surgery. All dislocations were late and occurred within the capsular bag. No early dislocations were reported.

Results also showed that of 287 patients at risk, 33 (12%) had minor pseudophakodonesis, four (1.3%) had moderate pseudophakodonesis and two (0.7%) had pronounced pseudophakodonesis.

"In conclusion, in-the-bag IOL dislocation or decentration is a late complication of cataract surgery that is more likely to happen in certain predisposed eyes," the author said. "Prognosis after treatment generally is good."