Trauma-related conditions may be notable risk factor for late in-the-bag IOL dislocation
Key takeaways:
- An analysis found a slight predominance of late in-the-bag IOL dislocations in men.
- Capsular tension rings may be a protective factor against dislocation.
Late in-the-bag IOL dislocation has a number of risk factors, including trauma-related conditions, as well as protective factors, according to a study published in the Journal of Cataract & Refractive Surgery.
“Although numerous risk factors for ITB dislocations have previously been detected in multiple investigations, a detailed review analyzing risk factors for this condition is still required,” Maximilian Gabriel, MD, PhD, FEBO, of the Medical University of Graz, Austria, and colleagues wrote. “The aim of this study therefore was to provide a structured analysis of risk factors for late ITB IOL dislocations to help physicians gauge their individual patients’ risk for this complication and manage them accordingly.”
Gabriel and colleagues analyzed 18,614 cases of late in-the-bag (ITB) IOL dislocations from 39 studies from the PubMed (Medline) database to determine the risks and protective factors of the complication.
In-the-bag IOL dislocations typically occurred in patients between the ages of 70 and 85 years old, with a slight predominance in men. The data suggested that trauma-related conditions are likely to be “significantly associated” with these dislocations.
While no risk factors could be identified in about one-fourth of patients, zonular dehiscence, previous vitrectomy, retinitis pigmentosa, pseudoexfoliation (PEX), high myopia, glaucoma, corneal endothelial damage and uveitis were risk factors with a good level of evidence.
“Hydrophilic, quadripode and haptic-angulation IOLs are further risk factors,” the authors wrote.
In 87.5% of the studies that reported time to dislocation, intervals ranged between 6 and 11 years.
Overall, implantation of a capsular tension ring (CTR) may be a protective factor against dislocation, as well as Nd:YAG capsulotomy, three-piece IOLs and IOLs with large optic diameters.
“The available data indicate that CTRs have a protective effect but may be interpreted as risk factors using nonadvanced statistics because they are usually implanted in high-risk
patients (eg, intraoperative zonular dehiscence or PEX),” the authors wrote.
Collapse
Read more about