eMedicine Specialties > Ophthalmology > Lens

Intraocular Lens Dislocation: Follow-up

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

Follow-up

Further Outpatient Care

  • Patients should receive follow-up care as needed.

Deterrence/Prevention

  • The anterior segment surgeon should be advised to avoid implantation of a flexible silicone plate IOL if there is a break in the posterior capsule, radial notch, or tear in the anterior capsular rim or zonular dialysis.
  • Small capsulorrhexis openings should be avoided.
  • Current models of ACIOLs often do not result in the same types of complications as older models. These lenses should be considered if adequate capsular support is lacking rather than risking a posterior dislocation of an IOL.

Complications

  • Complications from a dislocated IOL

    • Vitreous hemorrhage
    • Retinal detachment has been estimated to occur in at least 2% of cases. It frequently is caused by attempts at relocation by the cataract surgeon or as a complication of vitreoretinal surgery.
    • Cystoid macular edema
    • Uncorrected aphakia, glare, or distortion
  • Complications from transscleral suture fixation

    • Late endophthalmitis through the suture track has been reported.
    • IOL torque may occur. In addition, to place the IOL truly in the sulcus, the suture must be placed 0.8 mm posterior to the limbus in the vertical meridian and 0.46 mm in the horizontal meridian. The effective lens power is probably less than the desired one.
    • Vitreous hemorrhage may occur if the major arterial circle of the iris is pierced inadvertently during the maneuvers required to suture the IOL. In addition, these maneuvers also may raise the risk of a postoperative retinal detachment.
    • Erosion of the suture through the conjunctiva also has been reported in cases where scleral flaps were used. An attempt to melt the eroded sutures with the argon laser has been recommended. The sutures cannot be removed because the IOL haptics do not scar into place if placed in the ciliary sulcus. Once the sutures are removed, the IOL will redislocate.

Prognosis

  • With proper vitreoretinal techniques, excellent visual results and a low complication rate is possible. Long-term prognosis is highly dependent on the prevention of retinal detachment and choroidal hemorrhage secondary to surgical manipulation.

Miscellaneous

Medicolegal Pitfalls

  • The cataract surgeon should avoid any manipulation in the vitreous cavity and allow the vitreoretinal surgeon to manage posterior dislocation.
 


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
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References

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Further Reading

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Keywords

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

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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.

 
 
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