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Possible Predisposing Factors for In-the-bag Dislocation of Intraocular Lens and Surgical Outcomes of Reposition or Exchange of Dislocated Intraocular Lens. Wan-Soo Kim 1 , Chang-Kyu Lee 2 , Jung Hyun Jang 2 Haeundae Paik Hospital Inje university 1 Maryknoll Medical Center 2.

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Possible Predisposing Factors for In-the-bag Dislocation of Intraocular Lens and Surgical Outcomes of Reposition or Exchange of Dislocated Intraocular Lens

Wan-Soo Kim1, Chang-Kyu Lee2, Jung Hyun Jang2

Haeundae Paik Hospital

Inje university1

Maryknoll Medical Center2

The authors have no financial interest in the subject matter of this poster


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Subject

  • To examine the possible predisposing factors for intraocular lens(IOL) dislocation within the capsular bag(in-the-bag dislocation) and to study surgical outcomes of reposition or exchange of IOLs

  • Design : Retrospective interventional case series

  • Statistical analysis method

    • Relative risk

    • T-test

    • Significance : P-value < 0.05


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Patient Demographics

Table 1. Patient Demographics (Mean ± SD)

† Cases that didn’t occur late onset complications of In-the-bag dislocation of IOL

managed at the Maryknoll Medical Center in 2008

* At time of intraocular lens exchange or reposition surgery

‡ From cataract surgery tovisual disturbance symptom onset


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Outcome index

Preoperative index

IOL type

1-piece PMMA

3-piece PMMA

3-piece acrylic

3-piece silicone

Nd:YAG capsulotomy

Presence, interval

Postoperative index

Surgical intervention

Best corrected visual acuity

IOP

Spherical equivalent

Refractive astigmatism

  • Predisposing conditions

    • Pseudoexfoliation syndrome

    • Trauma History

    • Ophthalmologic underlying disease

    • Previous vitreoretinal surgery

    • Surgical trauma

    • High myopia (Axial length)

    • Other zonular dehiscence factors


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Result

  • IOL type

† At time of intraocular lens exchange or reposition surgery

Figure 1. Types of dislocated IOL


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  • Nd-YAG capsulotomy

    • 2 case(5.1%)

    • Interval (procedure to dislocation) : 4.3 ± 3.4 mo.

  • Surgical intervention

    • IOL exchange / reposition : 15 / 23 case

      • 1 point / 2 point scleral fixation : 5 / 33 case

    • Other : 1 case

      • (Aphakic state in the case of pathologic myopia)


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Surgical outcome

Table 2. Surgical outcomes (Mean ± SD)

*Analasized by T-test


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IOL Exchange vs Reposition

Fig. 3 Intraocular pressure

Fig. 2 Best corrected visual acuity

Fig. 4 Corneal astigmatism


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Predisposing Factors

Table 3. Predisposing Factors


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  • Vitreoretinal surgery

    • 3case : Scleral buckling d/t RRD

  • Axial length

    • 25.32mm (±2.46)

    • 1 case : pathologic myopia, 34.76mm

  • Surgical trauma

    • Iatrogenic radial tear and zonular dialysis during the cataract surgery


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Relative risk (Case/%)

Table 4. Relative risk


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Discussion

  • Possible major predisposing factor for in-the-bag IOL dislocation are Pseudoexfolication, retinal pigmentosa, the status after vitrectomy and trauma

    - Ken Hayashi, Akira Hirata, Hideyuki Hayashi, 2007 by the AAO

  • Pseudoexfoliation, uveitis, myopia, and other diseases associated progressive zonular weakening and capsular contraction are the predisposing factor of in-the-bag IOL dislocation

    - Howard V. Gimbel, MPH, Garry P. Condon, Thomas Kohnen, Randall J. Olson, Ioannis Halkiadakis, JCRS 2005

  • Sufficiency time is necessary

    • For considering predisposing factors of dislocation

    • For clinical manifestations

  • Surgeons have to

    • Use techniques thought to be least traumatic to the zonule

    • describe zonular dehiscence during the surgery if it occurs


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