eMedicine Specialties > Ophthalmology > Lens

Intraocular Lens Dislocation

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

Introduction

Background

Cataract surgery is the most common operation performed by ophthalmologists. Although it has a very high success rate, certain complications may occur. Posterior dislocation of an intraocular lens (IOL) is an uncommon complication of cataract surgery and Nd:YAG posterior capsulotomy.

Pathophysiology

Posterior dislocation of an IOL may occur during or shortly after cataract surgery. In these cases, posterior capsular rupture or zonular dialysis usually is present. Rarely, it may occur following Nd:YAG capsulotomy or beyond the immediate postoperative period. Trauma may be a precipitant in these cases.

The IOL rarely dislocates completely onto the retinal surface. It usually lies meshed into the anterior vitreous with one haptic still adherent to the capsule or iris. It may cause a vitreous hemorrhage by mechanical contact with ciliary body vessels. The IOL may be related to retinal detachment or cystoid macular edema secondary to vitreous changes and may cause pupillary block or corneal contact with secondary corneal edema. On many occasions, it does not cause any complications and may be left alone if the patient is able to use aphakic spectacles or contact lenses.

Frequency

United States

It is estimated to occur in 0.2-1.8% of cataract surgery cases.

The frequency appears to have increased in the past few years because of the following reasons: (1) phacoemulsification has a steep learning curve, and, as it becomes more popular, more complications are occurring; (2) anterior segment surgeons are becoming more reluctant to place anterior chamber intraocular lenses (ACIOLs); (3) aggressive placement of posterior chamber IOL in the presence of capsular tears has become more common; and (4) silicone plate IOLs have become popular.

A longitudinal study reported that, in 85% of posterior chamber IOL exchange cases, the indication was decentration/dislocation of the lens.

Race

Race does not play a role in the pathogenesis of this condition.

Sex

No gender preference exists in this condition.

Age

Age is not related to this condition.

Clinical

History

  • Complications during cataract surgery

    • Posterior capsular rupture
    • Zonular dialysis
  • History of Nd:YAG capsulotomy
  • History of ocular trauma
  • Symptoms

    • A sudden loss of vision due to uncorrected aphakia, retinal detachment, cystoid macular edema, or vitreous hemorrhage.
    • If the IOL is mobile in the vitreous cavity, the patient may complain of unusual floaters or optical effects.

Physical

  • The posterior capsule usually has an obvious defect.
  • Zonular dialysis may be present.
  • The IOL may be freely mobile in the vitreous cavity; it may be in apparent contact with the retina; or it may have one haptic attached to the posterior capsule, iris, or ciliary body.

Causes

In general, the main cause of dislocation is lack of capsular support for the IOL. This may be caused by any of the following:

  • Unrecognized posterior capsule rupture
  • Progressive zonular dehiscence: Patients with pseudoexfoliation syndrome are at risk of developing zonular dehiscence. Late in-the-bag IOL dislocation is associated with pseudoexfoliation in more than 50% of cases.
  • Postoperative trauma
  • Silicone plate lenses deserve special attention. It is believed that progressive contraction of the capsular bag increases the tension on the IOL and causes it to bow posteriorly. Progressive contracture of the anterior capsulorrhexis opening (pursestring) may occur more commonly with silicone plate IOLs. Dehiscence anywhere in the capsular bag allows release of tension through expulsion of the implant. Silicone plate IOLs have been known to dislocate in the following situations:

    • Following an extension of a radial notch tear in the anterior capsular rim
    • Following a YAG capsulotomy, particularly if a large capsulotomy is made and if the haptics are placed asymmetrically or the IOL optics are too small; interval from YAG capsulotomy to dislocation ranges from immediately to many months
    • Following an equatorial capsular break from a YAG iridotomy
  • In a retrospective interventional case series, possible major predisposing factors for in-the-bag IOL dislocation were pseudoexfoliation, retinitis pigmentosa, prior vitrectomy, trauma, and a long axis. For out-of-the-bag dislocation, predisposing factors included secondary IOL implantation, surgical complications, mature cataract, and pseudoexfoliation.

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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