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An impending epidemic of lens/bag dislocations?
A number of peer-reviewed publications in the last 10 years have highlighted the frequency of delayed dislocations of IOLs and capsular bags in patients with pseudoexfoliation syndrome. This phenomenon appears to be related to progressive capsular shrinkage and contraction (phimosis) creating centripetal traction against the lens zonules, causing the already weak zonules to lose their support for the lens.
Pseudoexfoliation cases pose enough intraoperative risks that every surgeon breathes a sigh of relief at the end of a successful case. However, it appears that we need to think further into this matter to avoid long-term complications for these successfully implanted patients.
Fortunately, Lisa Brothers Arbisser, MD, has done much of the thinking for us. She recently produced an extremely informative video chock-full of surgical pearls for pseudoexfoliation cases that can be viewed here. Among my favorite techniques that Dr. Arbisser presents was the idea to capture the optic of the IOL through the capsulotomy to prevent future phimosis. This anecdotal evidence suggests that this technique has been successful in preventing at least extensive phimosis and may have saved some eyes. We owe Dr. Arbisser a collective thank you for putting this information in such a compact format and making it available to us, her colleagues. I invite readers to comment on their own experiences with lens/bag dislocations in pseudoexfoliation cases.