Pars plana vitrectomy for posteriorly dislocated intraocular lenses: risk factors and surgical approach
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ORIGINAL PAPER
Pars plana vitrectomy for posteriorly dislocated intraocular lenses: risk factors and surgical approach Sara Sella . Alexander Rubowitz . Shira Sheen-Ophir . Joseph R. Ferencz . Ehud I. Assia . Yokrat Ton
Received: 22 March 2020 / Accepted: 17 August 2020 Ó Springer Nature B.V. 2020
Abstract Purpose To present updated risk factors, anatomical and visual outcomes and a surgical approach to posteriorly dislocated intraocular lenses (IOL). Methods A retrospective case series review of patients presenting with posteriorly dislocated IOL to the vitreous was performed. All cases were managed surgically with pars plana vitrectomy (PPV) followed by IOL repositioning and refixation or IOL exchange. Clinical characteristics, risk factors for IOL dislocation, visual outcomes and intraoperative and postoperative complications were investigated.
Presented at the XXXIV Congress of the European Society of Cataract and Refractive Surgeons (ESCRS) meeting 2016, Copenhagen, Denmark.
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s10792-020-01570-7) contains supplementary material, which is available to authorized users. S. Sella (&) A. Rubowitz S. Sheen-Ophir J. R. Ferencz E. I. Assia Y. Ton Department of Ophthalmology, Meir Medical Center (affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel), 59 Tchernichovsky St., 44281 Kfar Saba, Israel e-mail: [email protected]
Results Forty patients with posteriorly dislocated IOL underwent 3-port PPV and lens retrieval at an average of 6.5 years after cataract surgery. The main causes of IOL dislocation were previous PPV, myopia, pseudoexfoliation syndrome, ocular trauma and recurrent intravitreal injections. The existing IOL was repositioned and secured in 90% of the cases. Visual acuity improved in 34 patients, maintained in 5 and deteriorated in 1. All IOLs were central and stable at final follow-up. Conclusion Posterior intraocular lens dislocation is becoming more prevalent. The main underlying causes found in this series were previous vitrectomy, myopia and recurrent intra-vitreal substance injections. Visual acuity improved in most cases after lens repositioning; however visual outcome is often limited due to associated ocular co-morbidities despite adequate lens position. Despite complete lack of zonular support, a posteriorly dislocated IOL can often be preserved by repositioning and fixation of the lens in the posterior chamber. Pathologies primarily associated with this type of lens malposition include history of vitrectomy, high myopia and multiple intravitreal substance injections. Keywords Intraocular lens dislocation Intraocular lens exchange Intravitreal injections Lens fixation Pars plana vitrectomy
E. I. Assia Ein-Tal Eye Center, Tel Aviv, Israel
123
Int Ophthalmol
Introduction
Surgical technique
As the complication of intraocular lens (IOL) malposition after cataract surgery becomes more prevalent, there
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