Features of Surgical Correction of Spontaneous Luxation of the Complex “IOL Posterior Chamber – Capsular Bag”

Luxation of intraocular lens in capsular bag several years after cataract surgery leads to a decrease in visual function and requires surgical treatment.
Aim: to determine effectiveness of various types of surgical treatment of late spontaneous dislocations of IOL in capsular bag.
Methods. Analysis of 123 case histories of patients with late IOL dislocation, operated in 2013–2015, was made. First group included patients with replaced IOLs dislocated into pupillary lens. Second group consisted of patients who underwent reposition and suture of IOL to iris. Examination was made before operation and 6–12 months after operation. Results. The average term from moment of IOL implantation to its luxation was 8.78 ± 4.85 years. II degree of dislocation was detected in 74 % of patients, III degree of dislocation – in 10 %, and IV degree – in 16 % of patients.
Uncorrected visual acuity was reduced to 0.15 ± 0.16; best corrected visual acuity to 0.31 ± 0.26. In 83.7 % of patients a pseudoexfoliation syndrome was detected. In 62.6 % of patients IOL luxation was accompanied byhydrodynamic disturbances. Best corrected visual acuity in period from 6 to 12 months after surgery was 0.40 ± 0.24, and after IOL reposition – 0.49 ± 0.22. In addition, after IOL replacement a significant increase in postoperative astigmatism was noted from –0.44 ± 0.84 to –1.96 ± 1.60 D (p < 0.001).
Conclusion. As a result of surgical treatment of late spontaneous IOL dislocations in both groups increase in distance uncorrected and best corrected visual acuity was noted. Insufficient visual functions after surgical treatment were caused by concomitant pathology as well as increased postoperative astigmatism.

1. Zhaboedov DG. Causes and risk factors for dislocation of IOL in the late post-operative period of cataract surgery. Tavricheskiy mediko-biologicheskiy vestnik. 2013; 16(3): 61-63. (In Russ.)

2. Dabrowska-Kloda K, Kloda T, Boudiaf S, Jakobsson G, Stenevi U. Incidence and risk factors of late in-the-bag intraocular lens dislocation: evaluation of 140 eyes between 1992 and 2012. J Cataract Refract Surg. 2015; 41(7): 1376-1382. doi: 10.1016/j. jcrs.2014.10.040

3. Hayashi K, Ogawa S, Manabe S, 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(3): 505-513. doi: 10.1007/s00417-016-3273-6

4. Shchuko A.G., Mishenko O.P., Senchenko N.Y., Iureva T.N. Risk factors and complications arising from late spontaneous dislocations of the complex “posterior chamber IOL – capsular bag” into the vitreous body. Fyodorov Journal of Ophthalmic Surgery. 2017; (1): 21-26. (In Russ.) doi: 10.25276/0235-41602017-1-21-26

5. Egorova AV, Vasiliev AV, Smolyakova GP. The results of surgical treatment of intraocular lens dislocation. Fyodorov Journal of Ophthalmic Surgery. 2017; (1): 6-9. (In Russ.) doi: 10.25276/02354160-2017-1-6-9

6. Ivanov DI, Kremeshkov MV, Bardasov DB. The technology and results of treatment of luxurious and subluxed complexes of an intraocular lens with a capsular bag. Sovremennye tekhnologii kataraktal’noy i refraktsionnoy khirurgii: Sbornik nauchnykh statey. Moscow; 2011. p. 113-116. (In Russ.)

7. Frolov MA, Gonchar PA, Frolov AM. The reposition of the deployed IOL in combination with a persistent increase in IOP (clinical case). Sovremennyye tekhnologii v oftalmologii. 2014; (3): 107-108. (In Russ.)

8. Holt DG, Young J, Stagg B, Ambati BK. Anterior chamber intraocular lens, sutured posterior chamber intraocular lens, or glued intraocular lens: where do we stand? Curr Opin Ophthalmol. 2012; 23(1): 62-67. doi: 10.1097/ICU.0b013e32834cd5e5

9. Osher RH, Snyder ME, Cionni RJ. Modification of the Siepser slip-knot technique. JCataract Refract Surg. 2005; 31(6): 1098-1100. doi: 10.1016/j.jcrs.2004.11.038