eMedicine Specialties > Ophthalmology > Lens

Intraocular Lens Dislocation: Differential Diagnoses & Workup

Author: Lihteh Wu, MD, Consulting Surgeon, Department of Ophthalmology, Vitreo-Retinal Section, Instituto De Cirugia Ocular, Costa Rica
Coauthor(s): Teodoro Evans, MD, Retina Fellow, Vitreo-Retinal Section, Instituto De Cirugia Ocular, Costa Rica; Rafael Alberto García, MD, Chief of Outpatient Services, Department of Ophthalmology, Hospital México of San José, Costa Rica
Contributor Information and Disclosures

Updated: Jul 25, 2007

Differential Diagnoses

Other Problems to Be Considered

Gradual or acute loss of vision in patients with intraocular lenses

Workup

Imaging Studies

  • If a vitreous hemorrhage or severe corneal edema is present, B-scan ultrasonic imaging should be used to determine the position of the IOL and the presence or absence of retinal detachment.

Histologic Findings

Studies in cadaver eyes indicate that transscleral sutures must exit the sclera 0.8 mm posterior to the limbus in the vertical meridian and 0.46 mm posterior to the limbus in the horizontal meridian to be within the true ciliary sulcus.

Postmortem studies disclosed that scarring does not occur in the vicinity of the sutured IOL. The haptics are surrounded by a thin fibrous capsule at their attachment site. The transscleral portion of the suture is characterized by the lack of inflammation. In addition, the suture tip usually is exposed externally. If the fixation sutures were cut, the IOL would dislocate back into the vitreous cavity. It was concluded that the stability of the IOL was primarily a result of intact transscleral sutures and not fibrous encapsulation or ciliary sulcus placement of the haptics.

More on Intraocular Lens Dislocation

Overview: Intraocular Lens Dislocation
Differential Diagnoses & Workup: Intraocular Lens Dislocation
Treatment & Medication: Intraocular Lens Dislocation
Follow-up: Intraocular Lens Dislocation
References
[ CLOSE WINDOW ]

References

  1. Bourke RD, Gray PJ, Rosen PH, Cooling RJ. Retinal detachment complicating scleral-sutured posterior chamber intraocular lens surgery. Eye. 1996;10 (Pt 4):501-8. [Medline].

  2. Campo RV, Chung KD, Oyakawa RT. Pars plana vitrectomy in the management of dislocated posterior chamber lenses. Am J Ophthalmol. Nov 15 1989;108(5):529-34. [Medline].

  3. Chan CK. An improved technique for management of dislocated posterior chamber implants. Ophthalmology. Jan 1992;99(1):51-7. [Medline].

  4. Chan CK, Agarwal A, Agarwal S, Agarwal A. Management of dislocated intraocular implants. Ophthalmol Clin North Am. Dec 2001;14(4):681-93. [Medline].

  5. Duffey RJ, Holland EJ, Agapitos PJ, Lindstrom RL. Anatomic study of transsclerally sutured intraocular lens implantation. Am J Ophthalmol. Sep 15 1989;108(3):300-9. [Medline].

  6. Flynn HW Jr. Pars plana vitrectomy in the management of subluxed and posteriorly dislocated intraocular lenses. Graefes Arch Clin Exp Ophthalmol. 1987;225(3):169-72. [Medline].

  7. Framme C, Hoerauf H, Roider J, Laqua H. Delayed intraocular lens dislocation after neodymium:YAG capsulotomy. J Cataract Refract Surg. Nov 1998;24(11):1541-3. [Medline].

  8. Gimbel HV, Condon GP, Kohnen T, Olson RJ, Halkiadakis I. Late in-the-bag intraocular lens dislocation: incidence, prevention, and management. J Cataract Refract Surg. Nov 2005;31(11):2193-204. [Medline].

  9. Gonzalez GA, Irvine AR. Posterior dislocation of plate haptic silicone lenses. Arch Ophthalmol. Jun 1996;114(6):775-6. [Medline].

  10. Hayashi K, Hirata A, Hayashi H. Possible predisposing factors for in-the-bag and out-of-the-bag intraocular lens dislocation and outcomes of intraocular lens exchange surgery. Ophthalmology. May 2007;114(5):969-75. [Medline].

  11. Heilskov T, Joondeph BC, Olsen KR, Blankenship GW. Late endophthalmitis after transscleral fixation of a posterior chamber intraocular lens. Arch Ophthalmol. Oct 1989;107(10):1427. [Medline].

  12. Joo CK, Shin JA, Kim JH. Capsular opening contraction after continuous curvilinear capsulorhexis and intraocular lens implantation. J Cataract Refract Surg. Jun 1996;22(5):585-90. [Medline].

  13. Kokame GT, Yamamoto I, Mandel H. Scleral fixation of dislocated posterior chamber intraocular lenses: Temporary haptic externalization through a clear corneal incision. J Cataract Refract Surg. May 2004;30(5):1049-56. [Medline].

  14. Lanzetta P, Menchini U, Virgili G, Crovato S, Rapizzi E. Scleral fixated intraocular lenses: an angiographic study. Retina. 1998;18(6):515-20. [Medline].

  15. Lewis H, Sanchez G. The use of perfluorocarbon liquids in the repositioning of posteriorly dislocated intraocular lenses. Ophthalmology. Jul 1993;100(7):1055-9. [Medline].

  16. Lubniewski AJ, Holland EJ, Van Meter WS, Gussler D, Parelman J, Smith ME. Histologic study of eyes with transsclerally sutured posterior chamber intraocular lenses. Am J Ophthalmol. Sep 15 1990;110(3):237-43. [Medline].

  17. Maguire AM, Blumenkranz MS, Ward TG, Winkelman JZ. Scleral loop fixation for posteriorly dislocated intraocular lenses. Operative technique and long-term results. Arch Ophthalmol. Dec 1991;109(12):1754-8. [Medline].

  18. Malbran ES, Malbran E Jr, Negri I. Lens guide suture for transport and fixation in secondary IOL implantation after intracapsular extraction. Int Ophthalmol. May 1986;9(2-3):151-60. [Medline].

  19. Marques FF, Marques DM, Osher RH, Freitas LL. Longitudinal study of intraocular lens exchange. J Cataract Refract Surg. Feb 2007;33(2):254-7. [Medline].

  20. Mittra RA, Connor TB, Han DP, Koenig SB, Mieler WF, Pulido JS. Removal of dislocated intraocular lenses using pars plana vitrectomy with placement of an open-loop, flexible anterior chamber lens. Ophthalmology. Jun 1998;105(6):1011-4. [Medline].

  21. Por YM, Chee SP. Posterior-assisted levitation: outcomes in the retrieval of nuclear fragments and subluxated intraocular lenses. J Cataract Refract Surg. Dec 2006;32(12):2060-3. [Medline].

  22. Ruiz-Moreno JM. Repositioning dislocated posterior chamber intraocular lenses. Retina. 1998;18(4):330-4. [Medline].

  23. Schecter RJ. Suture-wick endophthalmitis with sutured posterior chamber intraocular lens. J Cataract Refract Surg. 1990;16:1755-56.

  24. Schneiderman TE, Johnson MW, Smiddy WE, Flynn HW Jr, Bennett SR, Cantrill HL. Surgical management of posteriorly dislocated silicone plate haptic intraocular lenses. Am J Ophthalmol. May 1997;123(5):629-35. [Medline].

  25. Smiddy WE. Management of dislocated foldable intraocular lenses. Retina. Jul-Aug 2005;25(5):576-80. [Medline].

  26. Smiddy WE. Modification of scleral suture fixation technique for dislocated posterior chamber intraocular lens implants. Arch Ophthalmol. Jul 1998;116(7):967. [Medline].

  27. Smiddy WE, Flynn HW Jr. Management of dislocated posterior chamber intraocular lenses. Ophthalmology. Jun 1991;98(6):889-94. [Medline].

  28. Smiddy WE, Flynn HW Jr. Needle-assisted scleral fixation suture technique for relocating posteriorly dislocated IOLs. Arch Ophthalmol. Feb 1993;111(2):161-2. [Medline].

  29. Smiddy WE, Ibanez GV, Alfonso E, Flynn HW Jr. Surgical management of dislocated intraocular lenses. J Cataract Refract Surg. Jan 1995;21(1):64-9. [Medline].

  30. Solomon K, Gussler JR, Gussler C, Van Meter WS. Incidence and management of complications of transsclerally sutured posterior chamber lenses. J Cataract Refract Surg. Jul 1993;19(4):488-93. [Medline].

  31. Steinmetz RL, Brooks HL, Newell CK. Management of posteriorly dislocated posterior chamber intraocular lenses by vitrectomy and pars plana removal. Retina. Aug 2004;24(4):556-9. [Medline].

  32. Tuft SJ, Talks SJ. Delayed dislocation of foldable plate-haptic silicone lenses after Nd:YAG laser anterior capsulotomy. Am J Ophthalmol. Oct 1998;126(4):586-8. [Medline].

  33. Williams DF, Del Piero EJ, Ferrone PJ, Jaffe GJ, McDonald HR, Peters MA. Management of complications in eyes containing two intraocular lenses. Ophthalmology. Nov 1998;105(11):2017-22. [Medline].

[ CLOSE WINDOW ]

Further Reading

[ CLOSE WINDOW ]

Keywords

IOL dislocation, IOL, cataracts, cataract surgery, Nd:YAG posterior capsulotomy

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

Lihteh Wu, MD, Consulting Surgeon, Department of Ophthalmology, Vitreo-Retinal Section, Instituto De Cirugia Ocular, Costa Rica
Lihteh Wu, MD is a member of the following medical societies: American Academy of Ophthalmology, American Society of Retina Specialists, Association for Research in Vision and Ophthalmology, and Pan-American Association of Ophthalmology
Disclosure: Nothing to disclose.

Coauthor(s)

Teodoro Evans, MD, Retina Fellow, Vitreo-Retinal Section, Instituto De Cirugia Ocular, Costa Rica
Disclosure: Nothing to disclose.

Rafael Alberto García, MD, Chief of Outpatient Services, Department of Ophthalmology, Hospital México of San José, Costa Rica
Disclosure: Nothing to disclose.

Medical Editor

Brian A Phillpotts, MD, Former Vitreo-Retinal Service Director, Former Program Director, Clinical Assistant Professor, Department of Ophthalmology, Howard University College of Medicine
Brian A Phillpotts, MD is a member of the following medical societies: American Academy of Ophthalmology, American Diabetes Association, American Medical Association, and National Medical Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Simon K Law, MD, PharmD, Assistant Professor of Ophthalmology, Jules Stein Eye Institute; Chief of Section of Ophthalmology Surgical Services, Department of Veterans Affairs Healthcare Center, West Los Angeles
Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, American Glaucoma Society, and Association for Research in Vision and Ophthalmology
Disclosure: Nothing to disclose.

Managing Editor

Steve Charles, MD, Director of Charles Retina Institute; Clinical Professor, Department of Ophthalmology, University of Tennessee College of Medicine
Steve Charles, MD is a member of the following medical societies: American Academy of Ophthalmology, American Society of Retina Specialists, Macula Society, and Retina Society
Disclosure: Alcon Laboratories Consulting fee Consulting

CME Editor

Lance L Brown, OD, MD, Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri
Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy Sr, MD, Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences
Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology
Disclosure: Nothing to disclose.

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.