Visual outcome and complications of pars plana vitrectomy for dislocated intraocular lenses

OBJECTIVE

To report factors predicting the visual outcome and complications in eyes that underwent pars plana vitrectomy (PPV) to manage dislocated intraocular lenses (IOLs).

PATIENTS AND METHODS

A retrospective chart review was performed. Clinical data recorded from the patient charts include, demographic, preoperative, intraoperative, and postoperative, with emphasis on visual acuity, interval between IOL dislocation and pars plana vitrectomy, surgical method and complications. Patients with follow-up of less than three months were excluded.

RESULTS

Ninety-four patients were identified, 63 males and 31 females. Age ranged from 2 to 85 years (mean 52.6). The range of follow-up was 3 to 108 months (mean ± SD 19.4 ± 17.4 months). The final visual acuity was 20/50 or better in 52 (55.3%) eyes. Our analysis indicated that visual rehabilitation with IOL was significantly associated with better visual acuity as compared with eyes that were left aphakic (P = 0.0092). There was a trend toward a better visual outcome when PPV was performed within two weeks from the diagnosis of the dislocated IOL which was associated with good visual outcome (20/200 or better) in 85.7% of eyes compared with 78.8% of eyes. Management of IOL by interofixation was associated in (90.0%) of eyes with good vision (20/200 or better) compared to 76.1% eyes that had exchange of IOL through the limbus. Postoperative complications include cystoid macular edema in 9 (9.6%), glaucoma in 9 (9.6%), bullous keratopathy in 8 (8.5%), retinal detachments in 6 (6.4%) eyes, and relapsing uveitis in 2 (2%).

CONCLUSION

In this series, the final visual outcomes were improved and the rate of postoperative complications were low. Eyes that were pseudophakic had significantly good visual outcome compared with eyes that were left aphakic. To the best of our knowledge, this may be the largest study on dislocated IOL removal by PPV with good visual results compared to other studies.

Intraocular Lens Dislocation into the Anterior Chamber because of Repeated Eye-Poking in a Patient with Leber's Congenital Amaurosis

The dislocation of a posterior chamber intraocular lens (PC IOL) because of constant eye rubbing is unusual and has never been reported in a child with Leber's congenital amaurosis (LCA). A 4-year-old full-term girl with an ocular history of LCA presented to the emergency room with a single-piece PC IOL dislocated into the anterior chamber (AC) of the left eye. There was no history of trauma or any other surgical intervention. A specific behavior known as Franceschetti's oculo-digital sign is a characteristic feature of LCA; this sign consists of repeated pressing, poking, and rubbing of the eyes with knuckles and fingers to stimulate the photoreceptors. This behavior caused the dislocation of the PC IOL into the AC. The dislocated IOL was explanted, and the patient was provided with aphakic glasses.

Comparative long-term outcomes of vitrectomy combined with anterior chamber intraocular lens to intra-scleral haptic fixation of posterior chamber intraocular lens

PURPOSE

To evaluate the long-term clinical outcomes in patients with combined pars plana vitrectomy (PPV) with anterior chamber intraocular lens (ACIOL) to intrascleral haptic fixation (ISHF) using the Agarwal technique with fibrin glue to secure the scleral flap of a posterior chamber intraocular lens.

METHODS

Retrospective, consecutive, single-center, comparative case series. 83 eyes were studied. Patients with < 8 months of follow-up were excluded. Detailed pre-, intra-, and post-operative complications were analyzed using mixed model univariate analysis and t-test. Pre- and post-operative best corrected visual acuity (BCVA) was analyzed.

RESULTS

Twenty-five subjects met entry criteria. Mean age at time of surgery was 70.4 ± 17.7 years in the ACIOL group (n = 12) and 54.6 ± 21.1 years in the ISHF group (n = 13; p = 0.03). Mean follow-up was 38.2 months. Incidence of corneal decompensation was similar in the ACIOL and ISHF lens group (p = 0.93). There was no difference in the BCVA mean change or cystoid macular edema (CME) at the final visit between the groups (p = 0.47; p = 0.08), but there was a trend toward increased CME in the ACIOL group.

CONCLUSIONS

PPV with concomitant placement of either ACIOL or ISHF lens result in improvement in BCVA. Both procedures are well tolerated and result in favorable outcomes with long-term follow-up though varying patient populations do not allow precise comparison between the two groups.

A modified Yamane technique with a posterior approach in a case report of intraocular lens dislocation

INTRODUCTION

The Yamane intrascleral fixation technique is a widespread surgical approach used in ophthalmology to secure three-piece intraocular lenses (IOLs) without the use of sutures. This technique is particularly beneficial in cases where the capsular bag is not suitable for IOL implantation. By creating a flange at the tip of each haptic this procedure innovatively eliminates the need for additional securing materials. We report an alternative management of posterior intraocular lens (IOL) dislocation with a modified Yamane technique, performed in vitreous chamber.

CASE PRESENTATION

We describe the surgery of a 56-year-old male with posterior dislocation of the capsular bag and a three-piece IOL with Polymethylmethacrylate (PMMA) loops into the vitreous cavity. His medical history included retinal detachment treated with scleral buckling 40 years earlier and cataract surgery performed 4 years earlier. The patient underwent a 25-gauge pars plana vitrectomy. Scleral tunnels were created to externalize the PMMA loops and securing the IOL in a stable position according to the classic Yamane technique: a bimanual approach with a 30-gauge x 13 mm ultra-thin-walled needle and maxgrip forceps was used.

DISCUSSION

Modified Yamane technique performed in vitreous chamber, especially in selected cases of dislocated IOL with PMMA loops, may allow better handling of the IOL and the loop insertion. This modified technique, by reducing mechanical stress on the PMMA loops, contributes to long-term IOL integrity and lowers the risk of complications during surgery.

CONCLUSION

This technique may offer a reliable alternative for ophthalmic surgeons managing PMMA IOLs dislocations.