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SURGICAL OUTCOME OF LATE IN-THE-BAG INTRAOCULAR LENS DISLOCATION TREATED WITH PARS PLANA VITRECTOMY. Retina 2016; 36:576-81. [DOI: 10.1097/iae.0000000000000738] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Hayashi K, Ogawa S, Manabe SI, Hirata A, Yoshimura K. A classification system of intraocular lens dislocation sites under operating microscopy, and the surgical techniques and outcomes of exchange surgery. Graefes Arch Clin Exp Ophthalmol 2016; 254:505-13. [PMID: 26816295 PMCID: PMC4769725 DOI: 10.1007/s00417-016-3273-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Accepted: 01/12/2016] [Indexed: 12/03/2022] Open
Abstract
Purpose The aim of this study was to examine the recent status of intraocular lens (IOL) dislocation according to a classification system based on vertical dislocation position, as well as the surgical techniques and outcomes of IOL exchange surgery. Methods The medical records of 230 eyes from 214 consecutive patients who experienced IOL dislocation and underwent exchange surgery between 2006 and 2014 were reviewed. Vertical dislocation sites observed preoperatively under operating microscopy were examined, along with the surgical techniques and outcomes of IOL exchange. Results Dislocation sites included (1) the anterior chamber (12.2 %), (2) pseudophakodonesis (19.1 %), (3) the anterior vitreous cavity (47.4 %), (4) trap door-like dislocation (dangling in the peripheral vitreous cavity; 16.1 %), and (5) the retinal surface (5.2 %). The IOL retained in the anterior segment was moved onto the iris by pulling it up through the limbal side ports with an anterior vitrectomy (67.8 %), or by pushing it up from the pars plana with an anterior vitrectomy (26.5 %), while the IOL dropped on the retina was lifting it up from the retina after pars plana vitrectomy (5.7 %). Mean uncorrected and distance-corrected visual acuity significantly improved postoperatively (p < 0.0001). Major complications included a marked elevation in intraocular pressure (7.8 %), pupillary capture (6.5 %), and vitreous hemorrhage (2.6 %). Conclusions Based on the classification system, approximately 95 % of dislocated IOLs were retained in the anterior segment, and these IOLs were exchanged using an anterior approach through limbal incisions with an anterior vitrectomy. Visual acuity improved significantly, and serious complications were uncommon, probably because the IOL exchange techniques were standardized and simplified without pars plana vitrectomy.
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Affiliation(s)
- Ken Hayashi
- Hayashi Eye Hospital, 4-23-35 Hakataekimae, Hakata-Ku, Fukuoka, 812-0011, Japan.
| | - Soichiro Ogawa
- Hayashi Eye Hospital, 4-23-35 Hakataekimae, Hakata-Ku, Fukuoka, 812-0011, Japan
| | - Shin-Ichi Manabe
- Hayashi Eye Hospital, 4-23-35 Hakataekimae, Hakata-Ku, Fukuoka, 812-0011, Japan
| | - Akira Hirata
- Hayashi Eye Hospital, 4-23-35 Hakataekimae, Hakata-Ku, Fukuoka, 812-0011, Japan
| | - Koichi Yoshimura
- Hayashi Eye Hospital, 4-23-35 Hakataekimae, Hakata-Ku, Fukuoka, 812-0011, Japan
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Jusef JN, Jusef SN, Avetisov KS, Vvedenskij AS. [Technique for surgical repositioning of in-the-bag dislocated intraocular lenses]. Vestn Oftalmol 2016; 132:53-56. [PMID: 27030435 DOI: 10.17116/oftalma2016132153-56] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
AIM to develop and test a new technique for surgical repositioning of in-the-bag dislocated intraocular lenses (IOLs). MATERIAL AND METHODS Surgical outcomes of 21 patients with in-the-bag IOL dislocation were analyzed (follow-up period 1-12 years). RESULTS The proposed method of IOL-capsular bag complex fixation with two double sutures provides a reliable anatomic and functional result. CONCLUSION The new technique enables surgical repositioning of in-the-bag dislocated IOLs following trauma in patients who have not had an intracapsular ring implanted before.
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Affiliation(s)
- Ju N Jusef
- Yu.N. YUSEF, S.N. YUSEF, K.S. AVETISOV, A.S. VVEDENSKIY
| | - S N Jusef
- Yu.N. YUSEF, S.N. YUSEF, K.S. AVETISOV, A.S. VVEDENSKIY
| | - K S Avetisov
- Yu.N. YUSEF, S.N. YUSEF, K.S. AVETISOV, A.S. VVEDENSKIY
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Gekka T, Ogawa T, Ohkuma Y, Katagiri S, Shiba T, Tsuneoka H. Trisection technique for the extraction of dislocated intraocular lenses through a small surgical incision. J Cataract Refract Surg 2015; 41:2040-2. [PMID: 26703277 DOI: 10.1016/j.jcrs.2015.09.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Revised: 06/09/2015] [Accepted: 06/16/2015] [Indexed: 10/22/2022]
Abstract
UNLABELLED We describe a trisection technique for extracting a dislocated IOL through a small surgical incision. The dislocated IOL is brought into the anterior chamber and cut into 3 equal segments, with a negligible risk for the segments falling into the vitreous cavity. FINANCIAL DISCLOSURE No author has a financial or proprietary interest in any material or method mentioned.
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Affiliation(s)
- Tamaki Gekka
- From the Department of Ophthalmology (Gekka, Ogawa, Ohkuma, Katagiri, Shiba, Tsuneoka), Jikei University School of Medicine, and the Department of Ophthalmology (Shiba), Daisan Hospital, Jikei University School of Medicine, Tokyo, Japan.
| | - Tomoichiro Ogawa
- From the Department of Ophthalmology (Gekka, Ogawa, Ohkuma, Katagiri, Shiba, Tsuneoka), Jikei University School of Medicine, and the Department of Ophthalmology (Shiba), Daisan Hospital, Jikei University School of Medicine, Tokyo, Japan
| | - Yasuhiro Ohkuma
- From the Department of Ophthalmology (Gekka, Ogawa, Ohkuma, Katagiri, Shiba, Tsuneoka), Jikei University School of Medicine, and the Department of Ophthalmology (Shiba), Daisan Hospital, Jikei University School of Medicine, Tokyo, Japan
| | - Satoshi Katagiri
- From the Department of Ophthalmology (Gekka, Ogawa, Ohkuma, Katagiri, Shiba, Tsuneoka), Jikei University School of Medicine, and the Department of Ophthalmology (Shiba), Daisan Hospital, Jikei University School of Medicine, Tokyo, Japan
| | - Takuya Shiba
- From the Department of Ophthalmology (Gekka, Ogawa, Ohkuma, Katagiri, Shiba, Tsuneoka), Jikei University School of Medicine, and the Department of Ophthalmology (Shiba), Daisan Hospital, Jikei University School of Medicine, Tokyo, Japan
| | - Hiroshi Tsuneoka
- From the Department of Ophthalmology (Gekka, Ogawa, Ohkuma, Katagiri, Shiba, Tsuneoka), Jikei University School of Medicine, and the Department of Ophthalmology (Shiba), Daisan Hospital, Jikei University School of Medicine, Tokyo, Japan
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Epidemiology, Etiology, and Prevention of Late IOL-Capsular Bag Complex Dislocation: Review of the Literature. J Ophthalmol 2015; 2015:805706. [PMID: 26798506 PMCID: PMC4698990 DOI: 10.1155/2015/805706] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2015] [Revised: 11/29/2015] [Accepted: 12/02/2015] [Indexed: 11/18/2022] Open
Abstract
Posterior chamber intraocular lens (PC-IOL) subluxation is uncommon but represents one of the most serious complications following phacoemulsification. Late spontaneous IOL-capsular bag complex dislocation is defined as occurring three months or later following cataract surgery. Unlike early IOL dislocation, late spontaneous IOL dislocation is due to a progressive zonular dehiscence and contraction of the capsular bag many years what seemed to be uneventful surgery. In recent years, late in-the-bag IOL subluxation or dislocation has been reported with increasing frequency, having a cumulative risk of IOL dislocation following cataract extraction of 0.1% after 10 years and 1.7% after 25 years. A predisposition to zonular insufficiency and capsular contraction is identified in 90% of reviewed cases. Multiple conditions likely play a role in contributing to this zonular weakness and capsular contraction. Pseudoexfoliation is the most common risk factor, accounting for more than 50% of cases. Other associated conditions predisposing to zonular dehiscence are aging, high myopia, uveitis, trauma, previous vitreoretinal surgery, retinitis pigmentosa, diabetes mellitus, atopic dermatitis, previous acute angle-closure glaucoma attack, and connective tissue disorders. The recognition of these predisposing factors suggests a modified approach in cases at risk. We review certain measures to prevent IOL-bag complex luxation that have been proposed.
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SURGICAL OUTCOME OF SIMULTANEOUS INTRAOCULAR LENS RESCUE AND SUTURELESS INTRASCLERAL TUNNEL FIXATION OF DISLOCATED INTRAOCULAR LENSES. Retina 2015; 35:1450-7. [PMID: 26102441 DOI: 10.1097/iae.0000000000000484] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To report short-term surgical outcomes of single-stage simultaneous rescue and sutureless intrascleral fixation of dislocated intraocular lens (IOLs). METHODS Sixteen eyes of 16 patients who underwent simultaneous rescue and intrascleral fixation of dislocated 3-piece IOLs were retrospectively evaluated. Partial thickness limbal-based scleral flaps (2.0 × 2.0 mm) were created, and a 22-gauge round needle was used to create a sclerotomy at 1.5 mm from the limbus under the previously created scleral flap, and a 23-gauge trans pars plana vitrectomy was performed. Bimanual maneuvers using two 23-gauge end-grasping forceps under chandelier illumination and a wide-angle viewing system enabled 1 step rescue of IOLs from the posterior vitreous cavity with 1 hand and simultaneous haptic externalization through sclerotomy with the other hand. An externalized haptic was placed into the 3-mm intrascleral tunnel created using a bent 26-gauge needle. Fibrin glue was used to fixate haptics and close the scleral flaps. RESULTS Intraocular lenses were successfully rescued and sclera-fixated through intrascleral tunnels in all 16 eyes (mean age, 56.56 ± 19.89 years). The mean preoperative logarithm of the minimum angle of resolution best-corrected visual acuity was 0.92 ± 0.68, and this significantly improved at 6 months to 0.289 ± 0.36 (P = 0.003). During the follow-up period (10.1 ± 3.21 months), no significant change of endothelial cell count or central foveal thickness was noted postoperatively (P = 0.203 and P = 0.979, respectively). There were no significant postoperative complications such as IOL dislocation, IOL decentration, retinal detachment, endophthalmitis, or postoperative hypotony. CONCLUSION Simultaneous rescue and sutureless intrascleral haptic fixation of dislocated 3-piece IOLs using bimanual maneuvers is an effective, safe, and minimally invasive surgical method to rescue and fixate the dislocated IOL without further explant.
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Liu E, Cole S, Werner L, Hengerer F, Mamalis N, Kohnen T. Pathologic evidence of pseudoexfoliation in cases of in-the-bag intraocular lens subluxation or dislocation. J Cataract Refract Surg 2015; 41:929-35. [DOI: 10.1016/j.jcrs.2014.08.037] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Revised: 08/19/2014] [Accepted: 08/19/2014] [Indexed: 11/16/2022]
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Oliphant H, Holmes C, Hassan A, Kon C. Sudden visual loss: intraocular lens subluxation. BMJ Case Rep 2014; 2014:bcr-2014-206811. [PMID: 25225194 DOI: 10.1136/bcr-2014-206811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Huw Oliphant
- Department of Ophthalmology, Worthing Hospital, Worthing, West Sussex, UK
| | - Christopher Holmes
- Department of Ophthalmology, Worthing Hospital, Worthing, West Sussex, UK
| | - Ali Hassan
- Department of Ophthalmology, Worthing Hospital, Worthing, West Sussex, UK
| | - Chee Kon
- Department of Ophthalmology, Worthing Hospital, Worthing, West Sussex, UK
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Spontaneous bilateral anterior partial in-the-bag intraocular lens dislocation following routine annual eye examination. J Cataract Refract Surg 2014; 40:1561-4. [DOI: 10.1016/j.jcrs.2014.07.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Revised: 02/21/2014] [Accepted: 02/22/2014] [Indexed: 11/21/2022]
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Ostern AE, Sandvik GF, Drolsum L. Positioning of the posterior intraocular lens in the longer term following cataract surgery in eyes with and without pseudoexfoliation syndrome. Acta Ophthalmol 2014; 92:253-8. [PMID: 23280247 DOI: 10.1111/aos.12025] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE To assess long-term positioning of posterior chamber intraocular lenses within the capsular bag in eyes with pseudoexfoliation syndrome. METHODS The study includes 44 patients with pseudoexfoliation syndrome and 85 age-matched controls, who underwent cataract surgery in 2001 and 2002 at the Eye Department, Oslo University Hospital. In 2008, all patients were re-examined. A comparison of the extent of possible decentration in eyes with and without pseudoexfoliation syndrome was made by evaluating Scheimpflug images (Pentacam) of the anterior segment. RESULTS It was found that, 6-7 years following cataract surgery, posterior chamber intraocular lenses were positioned lower in eyes with pseudoexfoliation syndrome than in control eyes. The difference was statistically significant (p=0.01). Downward shift was associated with presence of glaucoma only in eyes with pseudoexfoliation syndrome (p=0.01). No patients had visual disturbances related to displacement of the intraocular lens. Three of the patients with pseudoexfoliation syndrome (6.8%) had observable pseudophacodonesis by slit-lamp examination, compared to one in the control group (1.2%). The study demonstrated that Pentacam is an appropriate instrument to measure decentration of intraocular lenses. CONCLUSION The study suggests that, 6-7 years after cataract surgery, the intraocular lenses within the capsular bag are more prone to decentration in pseudoexfoliation syndrome eyes, compared to controls.
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Affiliation(s)
- Atle Einar Ostern
- Department of Ophthalmology, Oslo University Hospital, NorwayDepartment of Ophthalmology, Oslo University Hospital and University of Oslo, Norway
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Østern AE, Sandvik GF, Drolsum L. Late in-the-bag intraocular lens dislocation in eyes with pseudoexfoliation syndrome. Acta Ophthalmol 2014; 92:184-91. [PMID: 23280186 DOI: 10.1111/aos.12024] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE To assess preoperative features, frequency, surgical approaches and outcomes of late in-the-bag dislocation of posterior chamber intraocular lenses (IOLs) in eyes with pseudoexfoliation syndrome. METHODS Seventy-seven patients (81 eyes) were enrolled. Inclusion criteria were patients with pre-existing pseudoexfoliation syndrome who underwent surgery for late in-the-bag IOL dislocation between March 2004 and April 2010. Medical records were reviewed. Data from before and after secondary surgery were analysed. RESULTS Mean time between cataract extraction and secondary surgery for late in-the-bag dislocation of posterior chamber IOLs was 8.5 years. The increase in frequency within the reviewed period was statistically significant, ranging from six patients in the first year to 25 patients in the final year (p = 0.004). When surgical correction was performed within 1 month of referral, deterioration of the dislocation occurred in only one of 23 patients (4.3%). Complications, especially vitreous loss, occurred significantly more frequently during exchange surgery (n = 23) when compared with scleral suturing (n = 50) (p < 0.0001). After surgery, however, no differences in complications (p = 0.98) or best-corrected visual acuity (p = 0.74) was found. In general, following secondary surgery, there was a statistically significant improvement in best-corrected visual acuity (p < 0.0001). CONCLUSION The frequency of late in-the-bag dislocation of posterior chamber IOLs in eyes with pseudoexfoliation syndrome increased during the observation period. Our study suggests that surgical repair should not be delayed beyond 1 month and that scleral suturing is preferable to exchange surgery, because of less intraoperative complications.
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Affiliation(s)
- Atle Einar Østern
- Department of Ophthalmology, Oslo University Hospital, NorwayDepartment of Ophthalmology, Oslo University Hospital, NorwayDepartment of Ophthalmology, Oslo University Hospital and University of Oslo, Norway
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Indications and outcomes of intraocular lens exchange during a recent 5-year period. Am J Ophthalmol 2014; 157:154-162.e1. [PMID: 24182744 DOI: 10.1016/j.ajo.2013.08.019] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2013] [Revised: 08/21/2013] [Accepted: 08/23/2013] [Indexed: 11/24/2022]
Abstract
PURPOSE To analyze and classify the indications, clinical presentations, and surgical outcomes of intraocular lens (IOL) exchange performed in a recent 5-year period. DESIGN Retrospective, interventional case series. METHODS setting: Private clinical practice. study population: Chart records of 57 eyes of 53 consecutive patients who had undergone IOL exchange between May 2007 and December 2011 were reviewed. observation procedures and main outcome measures: The preoperative clinical characteristics, treatment parameters, intraoperative and postoperative complications, and pre- and postoperative logarithm of the minimal angle of resolution (logMAR) best-corrected visual acuity (BCVA) were recorded and analyzed. RESULTS IOL dislocation (46%), incorrect IOL power (23%), patient dissatisfaction (21%), and optic opacification (7%) were the most common indications for IOL exchange. In the IOL dislocation group, posterior capsule opening presented in 57% of eyes (8/14) with in-the-bag dislocation. Of the dissatisfaction patients, 42% (5/11) had undesired visual acuity without symptoms of glare/optical aberrations. Surface calcification of silicone lenses associated with asteroid hyalosis accounted for the most cases (3/4) of optic opacification. Overall, the mean logMAR BCVA improved significantly (P < .001) and 88% of all eyes were 20/40 or better, including 73% in the IOL dislocation group and 100% in all other groups. No vision-threatening complications occurred in this series. CONCLUSIONS The request for IOL exchange owing to patient dissatisfaction is increasing, especially for those with undesired visual acuity in the absence of photic symptoms. Surface calcification of silicone lenses suggests that this type of lens is not appropriate in the presence of asteroid hyalosis. Optimal visual results with a low rate of complications can be achieved in each category of indication. The findings of the study may stimulate discussion of a question: Does in-the-bag IOL dislocation occur only in eyes with an intact posterior capsule?
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Jakobsson G, Zetterberg M, Sundelin K, Stenevi U. Surgical repositioning of intraocular lenses after late dislocation: Complications, effect on intraocular pressure, and visual outcomes. J Cataract Refract Surg 2013; 39:1879-85. [DOI: 10.1016/j.jcrs.2013.06.023] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2013] [Revised: 05/30/2013] [Accepted: 06/02/2013] [Indexed: 11/25/2022]
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Benayoun Y, Petitpas S, Turki K, Adenis JP, Robert PY. Implants à fixation sclérale sans suture : série de neuf cas et revue de la littérature. J Fr Ophtalmol 2013; 36:658-68. [DOI: 10.1016/j.jfo.2012.09.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2012] [Revised: 09/14/2012] [Accepted: 09/24/2012] [Indexed: 11/29/2022]
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66
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Shingleton BJ, Yang Y, O’Donoghue MW. Management and outcomes of intraocular lens dislocation in patients with pseudoexfoliation. J Cataract Refract Surg 2013; 39:984-93. [DOI: 10.1016/j.jcrs.2013.01.044] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2012] [Revised: 01/26/2013] [Accepted: 01/28/2013] [Indexed: 12/01/2022]
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Secondary intraocular lens interventions: predisposing factors, indications and coincident procedures. Int Ophthalmol 2012; 33:111-5. [DOI: 10.1007/s10792-012-9635-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2012] [Accepted: 09/10/2012] [Indexed: 10/27/2022]
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Kontadakis GA, Kymionis GD, Kankariya VP, Pallikaris IG. Follow up of intraocular lens subluxation with a combined topographer/aberrometer. JOURNAL OF OPTOMETRY 2012; 5:147-149. [PMCID: PMC3861158 DOI: 10.1016/j.optom.2012.06.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2012] [Accepted: 06/22/2012] [Indexed: 06/10/2023]
Abstract
Purpose To report a 36-year-old patient with intraocular lens (IOL) subluxation that was followed for IOL stability with evaluation of images captured with the iTrace combined aberrometer/topographer. Methods The patient had undergone phacoemulsification with IOL implantation for congenital cataract 15 years before. He presented with bilateral IOL subluxation, more severe in his right eye. Right eye was operated for IOL exchange and left eye was followed with the iTrace images. The images were captured with an infrared camera, and the pupil, the pupil center and the corneal vertex could be detected. The subluxated IOLs edge was visible through infrared light retroillumination. IOL position was evaluated with respect to the pupil, the pupil center and the corneal vertex. Results The patient's left eye was followed for 7 months, and IOL position was noted to be stable. Thus no intervention was planned. Conclusion Evaluation of iTrace images is a reliable method to follow eyes with IOL subluxation.
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Affiliation(s)
- Georgios A. Kontadakis
- Institute of Vision and Optics (IVO), School of Health Sciences, University of Crete, Greece
| | - George D. Kymionis
- Institute of Vision and Optics (IVO), School of Health Sciences, University of Crete, Greece
| | - Vardhaman P. Kankariya
- Institute of Vision and Optics (IVO), School of Health Sciences, University of Crete, Greece
- Sai Surya Eye Care, Ahmednagar, Maharashtra, India
| | - Ioannis G. Pallikaris
- Institute of Vision and Optics (IVO), School of Health Sciences, University of Crete, Greece
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69
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Örnek K, Onaran Z. Refractory cystoid macular oedema due to intraocular lens haptic perforating the iris. Clin Exp Optom 2012; 95:553-4. [PMID: 22420405 DOI: 10.1111/j.1444-0938.2012.00717.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Cystoid macular oedema is a well-known complication of cataract surgery associated with intraocular lens decentration or dislocation. A 55-year-old man, who had undergone a phacoemulsification and intraocular lens implantation surgery two months previously was referred because of reduced vision in the right eye. Ocular examination revealed that one of the haptics had perforated the iris at 6 o'clock. There was cystoid macular oedema of the right eye. A topical non-steroid anti-inflammatory drug, followed by intravitreal injections did not produce a significant regression. Finally, the haptic was repositioned surgically and the macular oedema dramatically resolved. Correct placement of the intraocular lens might avoid post-operative complications including cystoid macular oedema.
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Affiliation(s)
- Kemal Örnek
- Department of Ophthalmology, School of Medicine, Kırıkkale University, Kırıkkale, Turkey.
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Shin JH, Lee JE, Oum BS. Clinical Outcomes of the Surgical Management with Dislocated Posterior Chamber Intraocular Lens. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2012. [DOI: 10.3341/jkos.2012.53.3.420] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Jong Hoon Shin
- Department of Ophthalmology, Medical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Ji Eun Lee
- Department of Ophthalmology, Medical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Boo Sup Oum
- Department of Ophthalmology, Medical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
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Single-suture scleral fixation of subluxated foldable intraocular lenses. Eur J Ophthalmol 2011; 22:547-53. [PMID: 22180152 DOI: 10.5301/ejo.5000094] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/14/2011] [Indexed: 01/08/2023]
Abstract
PURPOSE To evaluate the results of single-suture scleral fixation of subluxated foldable intraocular lenses (IOL) in eyes with sufficient residual capsular support. METHODS The results of IOL repositioning by single-suture scleral fixation in 6 eyes of 6 patients with IOL subluxation were included. All subluxated IOLs were single-piece hydrophilic acrylic. Subluxation resulted from posterior capsule tears in 3 eyes, zonular dialyses in 2 eyes, and zonular dialysis with a capsulorhexis tear in 1 eye. A similar technique was used in all eyes in which one haptic was externalized through a superior clear corneal incision and tied with a Pair-PAK 10-0 polypropylene suture, and was finally retracted and fixated behind the iris close to the ciliary sulcus at the 12:00 meridian. All patients were followed up for at least 6 months. RESULTS Best-corrected visual acuities ranged between finger counting and 20/70 (mean logMAR 1.02±0.64) preoperatively, and between 20/100 and 20/20 (mean logMAR 0.22±0.26) at the final postoperative visit. All IOLs remained centered and no significant postoperative complications were encountered except for an IOL tilt which resulted in a considerable oblique astigmatism in one eye. CONCLUSIONS Subluxated foldable IOLs may safely be repositioned and secured with a single scleral fixation suture in selected cases with adequate amount of capsular remnants.
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72
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Pueringer SL, Hodge DO, Erie JC. Risk of late intraocular lens dislocation after cataract surgery, 1980-2009: a population-based study. Am J Ophthalmol 2011; 152:618-23. [PMID: 21683329 DOI: 10.1016/j.ajo.2011.03.009] [Citation(s) in RCA: 94] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2011] [Revised: 03/05/2011] [Accepted: 03/07/2011] [Indexed: 11/30/2022]
Abstract
PURPOSE To estimate the long-term cumulative risk of late posterior chamber intraocular lens (IOL) dislocation after cataract extraction in a population-based cohort. DESIGN Retrospective cohort study and nested case-control study. METHODS The records of all residents of Olmsted County, Minnesota, who underwent cataract extraction from January 1, 1980, through May 31, 2009, (14 471 cases in 9577 residents) and who were diagnosed with late posterior chamber IOL dislocation in the same period were reviewed. Cases were identified through the Rochester Epidemiology Project. Three controls chosen from the cataract surgery cohort were matched to each IOL dislocation case by age, gender, and duration of follow-up. Records were reviewed to confirm case status and to ascertain risk factor information. The cumulative risk of IOL dislocation was estimated by using the Kaplan-Meier method. Logistic regression models assessed differences between cases and controls. RESULTS We identified 16 cases of late posterior chamber IOL dislocation, 9 with in-the-bag dislocations and 7 with out-of-the-bag dislocations. At 5, 10, 15, 20, and 25 years after cataract extraction, the cumulative risk of IOL dislocation was 0.1%, 0.1%, 0.2%, 0.7%, and 1.7%, respectively. There was no significant difference in the risk of late IOL dislocation after extracapsular cataract extraction when compared with phacoemulsification (P = .21) or between different decades of surgery (P = .92). Pseudoexfoliation and zonular laxity at surgery were associated significantly with late IOL dislocation (P = .01). CONCLUSIONS The long-term cumulative risk of late IOL dislocation after cataract extraction was low and did not significantly change over our nearly 30-year study period.
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Affiliation(s)
- Sam L Pueringer
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota 55905, USA
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73
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Oetting TA, Tsui JYM, Szeto AT. Sliding internal knot technique for late in-the-bag intraocular lens decentration. J Cataract Refract Surg 2011; 37:810-3. [PMID: 21511149 DOI: 10.1016/j.jcrs.2011.03.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2010] [Revised: 01/19/2011] [Accepted: 01/20/2011] [Indexed: 10/18/2022]
Abstract
We describe a technique that uses a sliding (Siepser) internal knot to secure the intraocular lens (IOL) and capsular bag complex to the sclera. The technique is helpful in cases of late dislocation of the IOL-capsular bag complex, which seems to be particularly common in patients with pseudoexfoliation. The technique, which borrows from earlier techniques, has the advantages of an external approach of the suture needle and a sliding knot with an internal tie that does not require a knot to be covered or rotated.
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Affiliation(s)
- Thomas A Oetting
- University of Iowa Hospital and Clinics and the Veterans Administration Medical Center, Iowa City, Iowa 52242, USA.
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74
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Singh R, Bhalekar S. Repositioning a dislocated intraocular lens in the ciliary sulcus using 23-gauge sutureless pars plana vitrectomy. J Cataract Refract Surg 2011; 37:438-40. [PMID: 21333866 DOI: 10.1016/j.jcrs.2010.12.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2010] [Revised: 09/30/2010] [Accepted: 10/05/2010] [Indexed: 11/18/2022]
Abstract
Intraocular lens (IOL) dislocation is a common complication of phacoemulsification. We describe a technique for retrieving a dislocated IOL using 23-gauge transconjunctival sutureless pars plana vitrectomy and repositioning the IOL in the ciliary sulcus in cases with adequate capsule support. This technique provides the benefits of sutureless surgery despite the complication of a dislocated IOL.
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Affiliation(s)
- Ramandeep Singh
- Department of Ophthalmology, Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
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Jakobsson G, Zetterberg M, Lundström M, Stenevi U, Grenmark R, Sundelin K. Late dislocation of in-the-bag and out-of-the bag intraocular lenses: Ocular and surgical characteristics and time to lens repositioning. J Cataract Refract Surg 2010; 36:1637-44. [DOI: 10.1016/j.jcrs.2010.04.042] [Citation(s) in RCA: 78] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2010] [Revised: 04/04/2010] [Accepted: 04/15/2010] [Indexed: 11/30/2022]
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Management of late spontaneous in-the-bag intraocular lens dislocation: Retrospective analysis of 45 cases. J Cataract Refract Surg 2010; 36:1270-82. [DOI: 10.1016/j.jcrs.2010.01.035] [Citation(s) in RCA: 97] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2009] [Revised: 01/18/2010] [Accepted: 01/27/2010] [Indexed: 11/22/2022]
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78
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Ma KT, Kang SY, Shin JY, Kim NR, Seong GJ, Kim CY. Modified Siepser sliding knot technique for scleral fixation of subluxated posterior chamber intraocular lens. J Cataract Refract Surg 2010; 36:6-8. [PMID: 20117698 DOI: 10.1016/j.jcrs.2009.07.048] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2009] [Revised: 07/25/2009] [Accepted: 07/28/2009] [Indexed: 10/20/2022]
Abstract
UNLABELLED We describe a new technique of scleral fixation for the management of dislocated intraocular lenses (IOL). A suture is tied inside the eye around the dislocated haptic to prevent slippage of the IOL after surgery. The technique, which is safe and less invasive than previous methods, was used in 3 patients and the results are presented. FINANCIAL DISCLOSURE No author has a financial or proprietary interest in any material or method mentioned.
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Affiliation(s)
- Kyoung Tak Ma
- Department of Ophthalmology, Yonsei University College of Medicine, Siloam Eye Hospital, Seoul, Korea
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79
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Dhesi S, Rajendram R, Elliott A. Realignment of a previously dislocated intraocular lens with a secondary intraocular lens: a rare cause of severe myopia. Eye (Lond) 2009; 24:1111. [PMID: 19942942 DOI: 10.1038/eye.2009.277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Mönestam EI. Incidence of dislocation of intraocular lenses and pseudophakodonesis 10 years after cataract surgery. Ophthalmology 2009; 116:2315-20. [PMID: 19815277 DOI: 10.1016/j.ophtha.2009.05.015] [Citation(s) in RCA: 79] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2008] [Revised: 05/11/2009] [Accepted: 05/12/2009] [Indexed: 11/28/2022] Open
Abstract
PURPOSE To estimate the incidence of early and late intraocular lens (IOL) dislocation and the frequency of pseudophakodonesis in a population-based cohort of cataract surgery cases. The patients were followed up from before to 10 years after surgery. DESIGN Cohort study. PARTICIPANTS Eight hundred ten cataract surgery patients. METHODS A prospective population-based cohort of 810 cataract surgery patients with presenile or senile cataracts was examined before surgery. Ten years later, 289 (73%) of 395 survivors agreed to participate in an eye examination. In addition to a routine eye examination of the anterior and posterior segment, all eyes were assessed for pseudophakodonesis and significant dislocation of the IOL. The medical records were studied and information concerning previous postoperative surgical interventions such as IOL exchange or repositioning was noted. This information was also obtained from the records of the deceased patients and those unable or unwilling to participate. The material was analyzed statistically. MAIN OUTCOME MEASURES Previous IOL exchange or repositioning surgery, significant IOL dislocation, and degree of pseudophakodonesis. RESULTS Most patients (n = 795/810; 98%) underwent sutureless clear corneal phacoemulsification surgery with a 3.2-mm temporal incision. A foldable IOL was implanted, 95% of which were an Alcon MA60BM AcrySof (Alcon Inc, Fort Worth, TX). Approximately 40% of the patients had pseudoexfoliations (PEX). After a 10-year follow-up, 5 (0.6%) of the 800 patients at risk required surgery for a dislocated IOL. All of these patients were male, and in all cases, the dislocation was late and within the capsular bag. The cumulative incidence over 10 years was 1%. At the examination 10 years after surgery, 2 (0.7%) of 287 patients at risk had pronounced pseudophakodonesis and 4 (1.4%) had moderate pseudophakodonesis. CONCLUSIONS The 10-year cumulative incidence of dislocated IOLs needing surgical attention was low in this population-based cohort with a high frequency of PEX. Early dislocation did not occur in any of the patients. The risk of this complication in an individual patient seems to be low. Because of the large number of people with previous cataract surgery, dislocated IOLs may cause a relatively large public health care burden.
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Affiliation(s)
- Eva I Mönestam
- Department of Clinical Sciences/Ophthalmology, Norrlands University Hospital, Umeå, Sweden.
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Shingleton BJ, Crandall AS, Ahmed IIK. Pseudoexfoliation and the cataract surgeon: Preoperative, intraoperative, and postoperative issues related to intraocular pressure, cataract, and intraocular lenses. J Cataract Refract Surg 2009; 35:1101-20. [DOI: 10.1016/j.jcrs.2009.03.011] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2009] [Accepted: 03/17/2009] [Indexed: 01/25/2023]
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