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3/13/2017 IntraocularLensDislocation:Background,Pathophysiology,Epidemiology

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IntraocularLensDislocation
Updated:Sep29,2015
Author:LihtehWu,MDChiefEditor:HamptonRoy,Sr,MDmore...

OVERVIEW

Background
Cataractsurgeryisthemostcommonoperationperformedbyophthalmologists.Althoughithasa
veryhighsuccessrate,certaincomplicationsmayoccur.Intraocularlens(IOL)malpositionsrange
fromsimpleIOLdecentrationtoluxationintotheposteriorsegment.SubluxatedIOLsinvolvesuch
extremedecentrationthattheIOLopticcoversonlyasmallfractionofthepupillaryspace.Luxation
involvestotaldislocationoftheIOLintotheposteriorsegment.DecentrationofanIOLmaybethe
resultoftheoriginalsurgicalplacementofthelens,oritmaydevelopinthepostoperativeperiod
becauseofexternal(eg,trauma,eyerubbing)orinternalforces(eg,scarring,peripheralanterior
synechiae[PAS],capsularcontraction,sizedisparity).Posteriordislocationofanintraocularlens
(IOL)isanuncommoncomplicationofcataractsurgeryandNd:YAGposteriorcapsulotomy.

SeeWhattheEyesTellYou:16AbnormalitiesoftheLens,aCriticalImagesslideshow,tohelp
recognizelensabnormalitiesthatarecluestovariousconditionsanddiseases.

Pathophysiology
IOLdislocationcanbesubdividedintoearlyandlatedislocation.Earlydislocationrefersto
dislocationoccurringwithin3monthsofcataractsurgery,whereaslatedislocationoccursmore
than3monthsaftercataractextraction.[1]

PosteriordislocationofanIOLmayoccurduringorshortlyaftercataractsurgery.Inthesecases,
posteriorcapsularruptureorzonulardialysisusuallyispresent.Itoccursbecauseofimproper
fixationwithinthecapsularbagandinstabilityoftheIOLcapsularbagcomplex.[2]The
implementationofacontinuouscurvilinearcapsulorrhexis(CCC)duringphacoemulsificationhas
decreasedtherateofearlyIOLdislocation.[3]CCCgivessupporttotheIOLopticfor360degrees
andpermitsexcellentIOLfixation.PriortoCCC,mostIOLdislocationoccurredsecondaryto
asymmetricIOLfixationorIOLmalpositionwithinthecapsularbag.Rarely,itmayoccurfollowing
Nd:YAGcapsulotomyorbeyondtheimmediatepostoperativeperiod.Traumamaybeaprecipitant
inthesecases.

LateIOLdislocationhasbeennotedtooccurmorefrequentlythanpreviouslythought.[1,4,5]Late
IOLdislocationresultsfromzonularweaknesssincetheIOLisadequatelyfixedwithinthecapsular
bag.Severalriskfactors,includingpseudoexfoliationsyndrome,[6]trauma,priorvitreoretinal
surgery,andconnectivetissuedisorders,havebeenassociatedwithzonularweakness.Ina
retrospectivecaseseriesof86lateIOLdislocations,theIOLdislocatedonaverage8.5yearsafter
phacoemulsificationandIOLimplantation.[1]Thesesameauthorsreportedthatpatientswithany
typeofIOLwereatriskforlateinthebagIOLdislocation.Apopulationbasedstudyofpatientsby
Pueringeretalfoundthataftercataractextraction,thelongtermriskoflateIOLdislocationwas
lowandhadnosignificantchangeoverthealmost30yearstudyperiod.[7]

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3/13/2017 IntraocularLensDislocation:Background,Pathophysiology,Epidemiology

TheIOLrarelydislocatescompletelyontotheretinalsurface.Itusuallyliesmeshedintothe
anteriorvitreouswithonehapticstilladherenttothecapsuleoriris.Itmaycauseavitreous
hemorrhagebymechanicalcontactwithciliarybodyvessels.TheIOLmayberelatedtoretinal
detachmentorcystoidmacularedemasecondarytovitreouschangesandmaycausepupillary
blockorcornealcontactwithsecondarycornealedema.Onmanyoccasions,itdoesnotcauseany
complicationsandmaybeleftaloneifthepatientisabletouseaphakicspectaclesorcontact
lenses.

Epidemiology
Frequency
UnitedStates

Clinicallyinsignificantdecentrationoccursinatleast25%ofcases.Clinicallysignificant
decentrationoccursinabout3%ofthecases.ThefrequencyofIOLdislocationrangesfrom0.2
1.8%.TherateislowerineyeswithposteriorchamberIOLs(PCIOL)thanwithanteriorchamber
IOLs(ACIOL)oririssupportedlenses.However,sinceposteriorchamberIOLsconstitutemost
lensesimplanted,decenteredanddislocatedposteriorchamberIOLshavebecomemore
prevalent.

Thefrequencyappearstohaveincreasedinthepastfewyearsbecauseofthefollowingreasons:
(1)phacoemulsificationhasasteeplearningcurve,and,asitbecomesmorepopular,more
complicationsareoccurring(2)anteriorsegmentsurgeonsarebecomingmorereluctanttoplace
anteriorchamberintraocularlenses(ACIOLs)(3)aggressiveplacementofposteriorchamberIOL
inthepresenceofcapsulartearshasbecomemorecommonand(4)siliconeplateIOLshave
becomepopular.

Alongitudinalstudyreportedthat,in85%ofposteriorchamberIOLexchangecases,theindication
wasdecentration/dislocationofthelens.

Race

Pseudoexfoliationsyndrome,byvirtueofitsweakeningeffectonthezonules,isoneofthemost
commonconditionsassociatedwithlateIOLdislocation.[1]Thepseudoexfoliationsyndromeis
commonlyseeninpeoplewithScandinavianheritage.

Sex
NogenderpreferenceexistsinIOLdislocation.

Age

Ageisnotrelatedtothiscondition.

ClinicalPresentation

References

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ContributorInformationandDisclosures

Author

LihtehWu,MDOphthalmologist,CostaRicaVitreoandRetinaMacularAssociates

LihtehWu,MDisamemberofthefollowingmedicalsocieties:AmericanAcademyof
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Ophthalmology,AmericanSocietyofRetinaSpecialists,AssociationforResearchinVisionand
Ophthalmology,ClubJulesGonin,MaculaSociety,PanAmericanAssociationofOphthalmology,
RetinaSociety

Disclosure:Receivedincomeinanamountequaltoorgreaterthan$250from:BayerHealth
QuantelMedicalHeidelbergEngineeringNovartis.

Coauthor(s)

RafaelAlbertoGarca,MD

Disclosure:Nothingtodisclose.

RobertHGraham,MDConsultant,DepartmentofOphthalmology,MayoClinic,Scottsdale,
Arizona

RobertHGraham,MDisamemberofthefollowingmedicalsocieties:AmericanAcademyof
Ophthalmology,ArizonaOphthalmologicalSociety,AmericanMedicalAssociation

Disclosure:PartnerreceivedsalaryfromMedscape/WebMDforemployment.

SpecialtyEditorBoard

SimonKLaw,MD,PharmDClinicalProfessorofHealthSciences,DepartmentofOphthalmology,
JulesSteinEyeInstitute,UniversityofCalifornia,LosAngeles,DavidGeffenSchoolofMedicine

SimonKLaw,MD,PharmDisamemberofthefollowingmedicalsocieties:AmericanAcademyof
Ophthalmology,AssociationforResearchinVisionandOphthalmology,AmericanGlaucoma
Society

Disclosure:Nothingtodisclose.

SteveCharles,MDDirectorofCharlesRetinaInstituteClinicalProfessor,Departmentof
Ophthalmology,UniversityofTennesseeCollegeofMedicine

SteveCharles,MDisamemberofthefollowingmedicalsocieties:AmericanAcademyof
Ophthalmology,AmericanSocietyofRetinaSpecialists,MaculaSociety,RetinaSociety,Club
JulesGonin

Disclosure:Receivedroyaltyandconsultingfeesfor:AlconLaboratories.

ChiefEditor

HamptonRoy,Sr,MDAssociateClinicalProfessor,DepartmentofOphthalmology,Universityof
ArkansasforMedicalSciences

HamptonRoy,Sr,MDisamemberofthefollowingmedicalsocieties:AmericanAcademyof
Ophthalmology,AmericanCollegeofSurgeons,PanAmericanAssociationofOphthalmology

Disclosure:Nothingtodisclose.

AdditionalContributors

BrianAPhillpotts,MD,MD

BrianAPhillpotts,MD,MDisamemberofthefollowingmedicalsocieties:AmericanAcademyof
Ophthalmology,AmericanDiabetesAssociation,AmericanMedicalAssociation,NationalMedical
Association

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Disclosure:Nothingtodisclose.

Acknowledgements

TeodoroEvans,MDConsultingSurgeon,VitreoRetinalSection,ClinicadeOjos,CostaRica

Disclosure:Nothingtodisclose.

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