Predisposing Factors and Surgical Outcomes of Intraocular Lens Dislocation after Phacoemulsification

Je Moon Yoon; Joo Hyun; Dong Hui Lim; Eui Sang Chung; Tae Young Chung

doi:10.3341/jkos.2016.57.1.36

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Yoon, Hyun, Lim, Chung, and Chung: Predisposing Factors and Surgical Outcomes of Intraocular Lens Dislocation after Phacoemulsification

Original Article

Journal of the Korean Ophthalmological Society 2015; 57(1): 36-42.

Published online: 29 August 2015

DOI: https://doi.org/10.3341/jkos.2016.57.1.36

Predisposing Factors and Surgical Outcomes of Intraocular Lens Dislocation after Phacoemulsification

Je Moon Yoon, M.D, Joo Hyun, M.D, Dong Hui Lim, M.D, Eui Sang Chung, M.D, PhD, Tae Young Chung, M.D, PhD

Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea

Address reprint requests to Tae Young Chung, MD, PhD Department of Ophthalmology, Samsung Medical Center, #81 Irwon-ro, Gangnam-gu, Seoul 06351, Korea Tel: 82-2-3410-3548, Fax: 82-2-3410-0029 E-mail: tychung@skku.edu

‗ This study was presented as a poster at the 111th Annual Meeting of the Korean Ophthalmological Society 2014.

Received 10 July 201522 August 2015 Accepted 16 October 2015

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To report the predisposing factors and surgical outcomes of intraocular lens dislocation (IOL) after phacoemulsification.

Methods

We performed a retrospective study of 131 eyes in 120 patients who were diagnosed with IOL dislocation after phacoe-mulsification between January 2008 and December 2013. The main outcomes are possible predisposing factors, characteristics of IOL dislocation, and outcomes of rectification surgery, including visual acuity (VA), and refractive status before and at 3 months after surgery.

Results

The main conditions associated with IOL dislocation were as follows: status after vitrectomy (27.5%), long axial length (9.2%), neodymium-doped yttrium aluminium garnet (Nd:YAG) posterior capsulotomy (8.4%), uveitis (6.1%), trauma (5.3%), mature cataract (3.8%), and pseudoexfoliation (2.3%). Mean uncorrected VA improved significantly after rectification surgery ( p = 0.00), and best-corrected VA also improved significantly ( p = 0.01). Mean value of spherical equivalent tended to decrease, al-though the decrease was not significant ( p = 0.07). Whereas astigmatism showed a significant increase ( p = 0.01). 6 eyes (4.6%) were associated with recurrence of IOL dislocation.

Conclusions

Possible major predisposing factors for IOL dislocation are status after vitrectomy, long axial length, Nd:YAG pos-terior capsulotomy, uveitis, and trauma. The surgical outcome and improvement of postoperative visual acuity were satisfactory.

Keywords: Intraocular lens dislocation, Phacoemulsification, Surgical outcome

References

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Table 1.

Characteristics of patients with intraocular lens dis-location

Total number of included eyes	131
Ages at time of rectification surgery (years, range)	60.6 ± 11.7 (24-91)
Ages at time of cataract surgery (years, range)	52.6 ± 13.5 (19-88)
Male (%)	110 (84.0)
Laterality (OD/OS)	66/65
Interval^* (months, range)	89.6 ± 64.7 (0-238)
Axial length (mm)	24.6 ± 2.2
Underlying medical condition
Diabetes mellitus (%)	40 (30.5)
Hypertension (%)	56 (42.8)
Previous cataract surgery (n, %)
At our medical center	66 (50.4)
At other hospital	65 (49.6)

Values are presented as mean ± SD unless otherwise indicated. OD = oculus dexter; OS = oculus sinister.

^* Between cataract surgery and rectification surgery.

Table 2.

Site and type of intraocular lens dislocation

	Data
Dislocation sites (N = 131)
Inferior	41 (31.3%)
Nasal	3 (2.3%)
Temporal	10 (7.6%)
Superior	8 (6.1%)
Into A/C	21 (16.0%)
In vitreous	32 (24.4%)
NA	16 (12.2%)
Dislocation type (N = 131)
In-the-bag	101 (77.1%)
Out-of-the-bag	30 (22.9%)

A/C = anterior chamber; NA = unidentifiable.

Table 3.

Material and design of dislocated IOL

	Data
Material of IOL (N = 131)
Acryl	67 (51.1%)
PMMA	7 (5.3%)
Silicone	5 (3.8%)
Hydrogel	1 (0.8%)
NA	51 (38.9%)
Design of IOL (N = 131)
One-piece	40 (30.5%)
Three-piece	80 (61.1%)
Others^*	1 (0.8%)
NA	10 (7.6%)

IOL = intraocular lens; PMMA = polymethyl methacrylate; NA = unidentifiable.

^* Accommodative intraocular lens.

Table 4.

Possible predisposing factors for intraocular lens dis-location

Predisposing factor (N = 131)	Eyes (%)
Status after vitrectomy	36 (27.5%)
Long axial length^*	12 (9.2%)
Nd:YAG posterior capsulotomy	11 (8.4%)
Uveitis	8 (6.1%)
Trauma	7 (5.3%)
Mature cataract	5 (3.8%)
Pseudoexfoliation	3 (2.3%)

Nd:YAG = neodymium-doped yttrium aluminium garnet.

^* Axial length ≥ 27.0 mm.

Table 5.

Comparison of predisposing factors between In-the-bag and Out-of-the-bag dislocation (N = 66)

Predisposing factor	In-the-bag (N = 49)	Out-of-the-bag (N = 17)	p-value^†
Status after vitrectomy Long axial length^*	14 (28.6%) 5 (10.2%)	5 (29.4%) 1 (5.9%)	1.00 1.00
Nd:YAG posterior capsulotomy	4 (8.2%)	1 (5.9%)	1.00
Uveitis	5 (10.2%)	0 (0.0%)	0.32
Trauma	1 (2.0%)	2 (11.8%)	0.16
Mature cataract	2 (4.1%)	0 (0.0%)	1.00
Pseudoexfoliation	1 (2.0%)	0 (0.0%)	1.00
Posterior capsular rupture	6 (12.2%)	8 (47.1%)	0.00

Nd:YAG = neodymium-doped yttrium aluminium garnet.

^* Axial length ≥ 27.0 mm;

^† Fisher’s exact test.

Table 6.

Surgical outcomes of rectification surgery after intraocular lens dislocation (N = 131)

	Pre-op	3 months post-op	p-value^*
UCVA (log MAR)	1.23 ± 0.78	0.60 ± 0.60	0.00
BCVA (log MAR)	0.50 ± 0.69	0.37 ± 0.63	0.01
SE (diopter)	+2.76 ± 6.00	-0.40 ± 1.21	0.07
Astigmatism (diopter)	-0.82 ± 0.97	-1.41 ± 1.01	0.01

Values are presented as mean ± SD unless otherwise indicated. Pre-op = preoperation; post-op = postoperation; UCVA = uncorrected visual acuity; BCVA = best corrected visual acuity; SE = spherical equivalent.

^* Paired t-test.

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