1 / 24

Intraocular lens (IOL) Dislocation

Intraocular lens (IOL) Dislocation. M.R. Akhlaghi MD. IOL dislocation Incidence. Intraocular lens (IOL) dislocation has been reported to occur in 0.2% to 1.8% of patients after cataract surgery. IOL dislocation Causes:.

wright
Download Presentation

Intraocular lens (IOL) Dislocation

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Intraocular lens (IOL) Dislocation M.R. Akhlaghi MD

  2. IOL dislocationIncidence • Intraocular lens (IOL) dislocation has been reported to occur in 0.2% to 1.8% of patients after cataract surgery

  3. IOL dislocationCauses: Main cause is sub optimal posterior capsule supports during or early post operative

  4. IOL dislocationCauses: During operation: • Unknowingly placement • Misjudging haptic placement • Misjudging capsule support At least 180 degree of a substantially broad rim of post. capsule at least half of which is in the interior quadrant is necessary for satisfactory PC IOL support.

  5. IOL dislocationCauses: Days of weeks after surgery: • Spontaneously IOL haptic rotation • Zonolar dehiscent

  6. IOL dislocationCauses: Months or years after surgery • Trauma • Spontaneously loss of zonolar support. (PEX), Marfan syn.

  7. IOL dislocationEvaluation: • Degree of lens malposition • Accompanying complications • Symptoms

  8. IOL dislocationEvaluation: Degree of lens malposition • Mild: the optic covering more than ½ pupilary space • Moderate: the optic covering less than ½ pupillary space • Subluxated: open pupillary space but in the anterior vitreous • Luxated: completely dislocation

  9. IOL dislocationEvaluation: Symptom & signs is related to degree of malposition: • Glare : related to edge of the IOL optic • Induced astigmatism • Decreased VA • Monocular Diplopia • Floater like symptoms: in luxated & complete mobile IOL • Pupillary block glaucoma: in luxated & complete mobile • Retinal trauma (in luxated & complete mobile)

  10. IOL dislocationEvaluation: Accompanying complications • Inflammation • increased IOP • Vitreous incarceration • Retinal damage • CME

  11. IOL dislocation management: • The best approach must be determined individually and is based on factors such as clinical circumstances and coexisting complications • Methods (non surgical, surgical) • Time of surgery • Method of surgery

  12. IOL dislocationmanagement: Non surgical management • Observation is usually recommended for IOLs with simple decentration • If aphakic contact lens correction is satisfactory, • If systemic or ocular problems prohibit further Surgery • If the patient simply elects not to pursue further surgery

  13. IOL dislocationmanagement surgical management • Usually non surgical methods is not satisfactory or convenient to the most of patients

  14. IOL dislocationSurgical management: Indications • decreased VA • persistent CME • Increased IOP and inflammation • coexisting RD • Retain lens material • monocular diplopia • halo phenomenon • fluctuating vision caused by shifting IOL

  15. IOL dislocationTime of Surgical management Optimal time for intervention • intraoperative IOL dislocation: • IOL dislocation days after operation: • dislocations occurring distantly:

  16. IOL dislocationsurgical management: • IOL removal • IOL exchange • IOL repositioning • Secondary IOL

  17. IOL dislocationsurgical management: Surgical approach • Limbal incision: in moderate decentration or subluxated if post. capsule is largely intact • Pars plana vitrectomy: In luxated IOL offer optimal control to achieve the goal of surgery in subluxated IOL specially if posterior migration occurs

  18. IOL dislocationsurgical management: IOL removal • RD • Inflammation • Trauma • IOL removal with or without exchangeis usually performed for IOLs with damaged haptics, small optics, or highly flexible haptics unsuitable for suture support

  19. IOL dislocationsurgical management: IOL exchange • Risk of endothelial cell trauma • Explantation & reimplantation may risk more corneal endothelial trauma compared with repositioning • Exchange for an AC.IOL causes less trauma to endothelial compared with PC IOL placement

  20. IOL dislocationsurgical managment: IOL Repositioninig • Most common elected approach • Three basic approaches • In the residual bag or sulcus • iris suture fixation • Scleral fixation Repositioning a PC IOL in AC may induce chronic iritis, inflammation, and corneal decompensation.

  21. IOL dislocationsurgical managment Secondary IOL: • (AC,PC) without explanation of dislocation IOL only in unusual circumstances

  22. IOL dislocation Outcomes & complications Final outcomes depends on • preoperative macular function • Post operative complication of original cataract surgery (CME & RD) • Complication of final operation

  23. IOL dislocation Outcomes & complications In some studies • VA > 20/40 50-94% • Initial coexisting RD 0-10% • combined rate of RD 0-16%

  24. IOL dislocation Recommendation • Anterior vitrectomy (avoid vitreous incarceration) • A second IOL should not be placed • Frequent topical steroids • If indicated IOP-reducing agent • Vitreoretinal refferal • Careful attention to detect other complications

More Related