Journal List > J Korean Ophthalmol Soc > v.55(2) > 1009877

Sun, Kim, Kim, Yoon, and Tchah: Comparison of Clinical Outcomes after Various Techniques of Intraocular Lens Dislocation Correction

Abstract

Purpose

To compare clinical outcomes of various surgical methods of intraocular lens dislocation correction surgery.

Methods

We retrospectively analyzed the medical records of patients who underwent intraocular lens dislocation correction surgery with and without vitrectomy by two seasoned surgeons, and compared postoperative best corrected visual acuity and spherical equivalent. Clinical outcomes of secondary intraocular lens insertion after primary intraocular lens removal and primary intraocular lens reposition were compared among the cases without vitrectomy.

Results

Dislocated intraocular lens correction without vitrectomy showed better postoperative visual acuity compared to procedures with vitrectomy (0.35 ± 0.37 vs. 0.54 ± 0.18; t-test, p = 0.001), but there were no significant differences in spherical equivalent (1.30 ± 1.10 vs. 1.80 ± 1.57; p = 0.24) between cases with and without vitrectomy. In comparing primary intraocular lens reposition and secondary intraocular lens insertion among the cases without vitrectomy, the outcomes did not show significant differences in best corrected visual acuity (0.28 ± 0.40 vs. 0.40 ± 0.37; p = 0.38) or spherical equivalent (1.66 ± 1.43 vs. 1.07 ± 0.79; p = 0.19). In comparing secondary intraocular lens insertion into the capsular bag and fixation to the sclera, iris and iris sulcus, the outcomes did not show significant differences in best corrected visual acuity (p = 0.49) or spherical equivalent (p = 0.33).

Conclusions

The various intraocular lens correction methods examined did not show clinically significant differences in best corrected visual acuity and spherical equivalent when performed by experienced surgeons, except for better post-operative best corrected visual acuity in cases without vitrectomy compared to cases with vitrectomy.

References

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Table 1.
Baseline characteristics of patients with intraocular lens dislocation
Baseline characteristics Total 45 eyes of 45 patients
Sex (male : female) 21/24
Age (years) 62.0 ± 7.3
Time of dislocation after cataract surgery (months) 7.2 ± 2.4
BCVA at preoperative visit (log MAR) 0.84 ± 0.73
Dropped IOL in vitreous (number, %) 10/45 (22)
Referred case (number, %) 42/45 (91)

Values are presented as mean ± SD.

Table 2.
Comparison of postoperative best-corrected visual acuity (BCVA), spherical equivalent, complication according to surgery types including pars plana vitrectomy with secondary IOL scleral fixation, Primary IOL Reposition, secondary IOL capsular bag reposition, secondary IOL scleral fixation, secondary IOL iris fixation, and secondary IOL iris sulcus fixation
Type of surgery Cases (%) Postoperative BCVA (log MAR) Postoperative spherical equivalent Complications (n)
Pars plana vitrectomy 12 (26) 0.54 ± 0.18 1.80 ± 1.50 0
with secondary IOL scleral fixation        
Primary IOL reposition 13 (28) 0.28 ± 0.40 1.66 ± 1.43 0
Secondary IOL sulcus reposition 5 (11) 0.36 ± 0.79 1.08 ± 0.84 0
Secondary IOL scleral fixation 11 (24) 0.51 ±0.36 1.23 ± 0.84 0
Secondary IOL iris fixation 3 (6) 0.23 ± 0.50 0.41 ± 0.37 0
Secondary IOL iris sulcus fixation 1 (2) 0 1.25 0
p-value   0.47 0.55 1

Values are presented as mean ± SD.

Table 3.
Comparison of preoperative & postoperative best-corrected visual acuity (BCVA), spherical equivalent, and complication rate between pars plana vitrectomy with scleral fixation and anterior approaching surgery without vitrectomy (Only 17 cases which have preoperative BCVA)
  Vitrectomy performed Vitrectomy not performed p-value
Preoperative BCVA before IOL dislocation (log MAR) 0.72 ± 0.19 0.40 ± 0.23 0.001*
(Numbers/ cases with preoperative data) (6/17) (11/17)  
Number (%) 12/45 (27%) 33/45 (63%)  
Postoperative BCVA (log MAR) 0.54 ± 0.18 0.35 ± 0.37 0.001*
Postoperative spherical equivalent (diopter) 1.80 ± 1.57 1.30 ± 1.10 0.24
Complications rate 0 0 1

Values are presented as mean ± SD.

* Statistically significant difference between two groups

Table 4.
Comparison of postoperative visual acuity, spherical equivalent, and complication rate between anterior approaching operations without vitrectomy with previous IOL reposition and that with secondary IOL implantation after pervious IOL removal
  Use of primary IOL Use of secondary IOL p-value
Number (%) 13/33 (39) 20/33 (61)  
Postoperative BCVA (log MAR) 0.28 ± 0.40 0.40 ± 0.37 0.39
Postoperative spherical equivalent (diopter) 1.66 ± 1.43 1.07 ± 0.79 0.19
Complications rate 0 0 1

Values are presented as mean ± SD.

Table 5.
Comparison of postoperative best corrected visual acuity (BCVA), spherical equivalent, and complication rate in various anterior approaching surgeries without vitrectomy with the use of secondary IOL according to the secondary IOL fixation technique including secondary IOL capsular bag reposition, secondary IOL scleral fixation, secondary IOL iris fixation, and secondary IOL iris sulcus fixation
  Secondary IOL sulcus reposition Secondary IOL with Scleral fixation Secondary IOL with Iris fixation Secondary IOL with Iris sulcus fixation p-value
Number of cases / secondary IOL group 5/20 (25%) 11/20 (55%) 3/20 (15%) 1/20 (5%)  
Mean visual acuity post operative (log MAR) 0.36 ± 0.79 0.51 ± 0.36 0.23 ± 0.5 0 0.33
Mean spherical equivalent post operative 1.08 ± 0.84 1.24 ± 0.84 0.42 ± 0.37 1.250 0.49
Complications rate 0 0 0 0 1

Values are presented as mean ± SD.

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