Professional Documents
Culture Documents
Thissiteisintendedforhealthcareprofessionals
IntraocularLensDislocation
Updated:Sep29,2015
Author:LihtehWu,MDChiefEditor:HamptonRoy,Sr,MDmore...
OVERVIEW
Background
Cataractsurgeryisthemostcommonoperationperformedbyophthalmologists.Althoughithasa
veryhighsuccessrate,certaincomplicationsmayoccur.Intraocularlens(IOL)malpositionsrange
fromsimpleIOLdecentrationtoluxationintotheposteriorsegment.SubluxatedIOLsinvolvesuch
extremedecentrationthattheIOLopticcoversonlyasmallfractionofthepupillaryspace.Luxation
involvestotaldislocationoftheIOLintotheposteriorsegment.DecentrationofanIOLmaybethe
resultoftheoriginalsurgicalplacementofthelens,oritmaydevelopinthepostoperativeperiod
becauseofexternal(eg,trauma,eyerubbing)orinternalforces(eg,scarring,peripheralanterior
synechiae[PAS],capsularcontraction,sizedisparity).Posteriordislocationofanintraocularlens
(IOL)isanuncommoncomplicationofcataractsurgeryandNd:YAGposteriorcapsulotomy.
SeeWhattheEyesTellYou:16AbnormalitiesoftheLens,aCriticalImagesslideshow,tohelp
recognizelensabnormalitiesthatarecluestovariousconditionsanddiseases.
Pathophysiology
IOLdislocationcanbesubdividedintoearlyandlatedislocation.Earlydislocationrefersto
dislocationoccurringwithin3monthsofcataractsurgery,whereaslatedislocationoccursmore
than3monthsaftercataractextraction.[1]
PosteriordislocationofanIOLmayoccurduringorshortlyaftercataractsurgery.Inthesecases,
posteriorcapsularruptureorzonulardialysisusuallyispresent.Itoccursbecauseofimproper
fixationwithinthecapsularbagandinstabilityoftheIOLcapsularbagcomplex.[2]The
implementationofacontinuouscurvilinearcapsulorrhexis(CCC)duringphacoemulsificationhas
decreasedtherateofearlyIOLdislocation.[3]CCCgivessupporttotheIOLopticfor360degrees
andpermitsexcellentIOLfixation.PriortoCCC,mostIOLdislocationoccurredsecondaryto
asymmetricIOLfixationorIOLmalpositionwithinthecapsularbag.Rarely,itmayoccurfollowing
Nd:YAGcapsulotomyorbeyondtheimmediatepostoperativeperiod.Traumamaybeaprecipitant
inthesecases.
LateIOLdislocationhasbeennotedtooccurmorefrequentlythanpreviouslythought.[1,4,5]Late
IOLdislocationresultsfromzonularweaknesssincetheIOLisadequatelyfixedwithinthecapsular
bag.Severalriskfactors,includingpseudoexfoliationsyndrome,[6]trauma,priorvitreoretinal
surgery,andconnectivetissuedisorders,havebeenassociatedwithzonularweakness.Ina
retrospectivecaseseriesof86lateIOLdislocations,theIOLdislocatedonaverage8.5yearsafter
phacoemulsificationandIOLimplantation.[1]Thesesameauthorsreportedthatpatientswithany
typeofIOLwereatriskforlateinthebagIOLdislocation.Apopulationbasedstudyofpatientsby
Pueringeretalfoundthataftercataractextraction,thelongtermriskoflateIOLdislocationwas
lowandhadnosignificantchangeoverthealmost30yearstudyperiod.[7]
http://emedicine.medscape.com/article/1211310overview 1/7
3/13/2017 IntraocularLensDislocation:Background,Pathophysiology,Epidemiology
TheIOLrarelydislocatescompletelyontotheretinalsurface.Itusuallyliesmeshedintothe
anteriorvitreouswithonehapticstilladherenttothecapsuleoriris.Itmaycauseavitreous
hemorrhagebymechanicalcontactwithciliarybodyvessels.TheIOLmayberelatedtoretinal
detachmentorcystoidmacularedemasecondarytovitreouschangesandmaycausepupillary
blockorcornealcontactwithsecondarycornealedema.Onmanyoccasions,itdoesnotcauseany
complicationsandmaybeleftaloneifthepatientisabletouseaphakicspectaclesorcontact
lenses.
Epidemiology
Frequency
UnitedStates
Clinicallyinsignificantdecentrationoccursinatleast25%ofcases.Clinicallysignificant
decentrationoccursinabout3%ofthecases.ThefrequencyofIOLdislocationrangesfrom0.2
1.8%.TherateislowerineyeswithposteriorchamberIOLs(PCIOL)thanwithanteriorchamber
IOLs(ACIOL)oririssupportedlenses.However,sinceposteriorchamberIOLsconstitutemost
lensesimplanted,decenteredanddislocatedposteriorchamberIOLshavebecomemore
prevalent.
Thefrequencyappearstohaveincreasedinthepastfewyearsbecauseofthefollowingreasons:
(1)phacoemulsificationhasasteeplearningcurve,and,asitbecomesmorepopular,more
complicationsareoccurring(2)anteriorsegmentsurgeonsarebecomingmorereluctanttoplace
anteriorchamberintraocularlenses(ACIOLs)(3)aggressiveplacementofposteriorchamberIOL
inthepresenceofcapsulartearshasbecomemorecommonand(4)siliconeplateIOLshave
becomepopular.
Alongitudinalstudyreportedthat,in85%ofposteriorchamberIOLexchangecases,theindication
wasdecentration/dislocationofthelens.
Race
Pseudoexfoliationsyndrome,byvirtueofitsweakeningeffectonthezonules,isoneofthemost
commonconditionsassociatedwithlateIOLdislocation.[1]Thepseudoexfoliationsyndromeis
commonlyseeninpeoplewithScandinavianheritage.
Sex
NogenderpreferenceexistsinIOLdislocation.
Age
Ageisnotrelatedtothiscondition.
ClinicalPresentation
References
1.DavisD,BrubakerJ,EspandarL,StringhamJ,CrandallA,WernerL.Lateinthebag
spontaneousintraocularlensdislocation:evaluationof86consecutivecases.
Ophthalmology.2009Apr.116(4):66470.[Medline].
2.GrossJG,KokameGT,WeinbergDV.Inthebagintraocularlensdislocation.AmJ
Ophthalmol.2004Apr.137(4):6305.[Medline].
http://emedicine.medscape.com/article/1211310overview 2/7
3/13/2017 IntraocularLensDislocation:Background,Pathophysiology,Epidemiology
3.GimbelHV,CondonGP,KohnenT,OlsonRJ,HalkiadakisI.Lateinthebagintraocularlens
dislocation:incidence,prevention,andmanagement.JCataractRefractSurg.2005Nov.
31(11):2193204.[Medline].
4.KrepsteL,KuzmieneL,MiliauskasA,JanulevicieneI.Possiblepredisposingfactorsforlate
intraocularlensdislocationafterroutinecataractsurgery.Medicina(Kaunas).2013.
49(5):22934.[Medline].
5.FernandezBuenagaR,AlioJL,PerezArdoyAL,etal.Lateinthebagintraocularlens
dislocationrequiringexplantation:riskfactorsandoutcomes.Eye(Lond).2013Jul.
27(7):795801quiz802.[Medline].[FullText].
6.ShingletonBJ,YangY,O'DonoghueMW.Managementandoutcomesofintraocularlens
dislocationinpatientswithpseudoexfoliation.JCataractRefractSurg.2013Jul.39(7):984
93.[Medline].
7.PueringerSL,HodgeDO,ErieJC.Riskoflateintraocularlensdislocationaftercataract
surgery,19802009:apopulationbasedstudy.AmJOphthalmol.2011Oct.152(4):61823.
[Medline].
8.TappinMJ,LarkinDF.Factorsleadingtolensimplantdecentrationandexchange.Eye
(Lond).2000Oct.14Pt5:7736.[Medline].
9.MamalisN,BrubakerJ,DavisD,EspandarL,WernerL.Complicationsoffoldableintraocular
lensesrequiringexplantationorsecondaryintervention2007surveyupdate.JCataract
RefractSurg.2008Sep.34(9):158491.[Medline].
10.AlHalafiAM,AlHarthiE,AlAmroS,ElAsrarAA.Visualoutcomeandcomplicationsofpars
planavitrectomyfordislocatedintraocularlenses.SaudiJOphthalmol.2011Apr.25(2):187
92.[Medline].
11.RusuI,ChenZ,ZizvaJ,MyungJS,WaldKJ.Incidenceofcystoidmacularedemawithiris
fixatedposteriorchamberintraocularlensesinpatientspresentingwithlensdislocation.Int
Ophthalmol.2014Oct.34(5):11538.[Medline].
12.JakobssonG,ZetterbergM,SundelinK,SteneviU.Surgicalrepositioningofintraocular
lensesafterlatedislocation:Complications,effectonintraocularpressure,andvisual
outcomes.JCataractRefractSurg.2013Dec.39(12):187985.[Medline].
13.GonnermannJ,KlamannMK,MaierAK,RjasanowJ,JoussenAM,BertelmannE,etal.
Visualoutcomeandcomplicationsafterposterioririsclawaphakicintraocularlens
implantation.JCataractRefractSurg.2012Dec.38(12):213943.[Medline].
14.YamaneS,InoueM,ArakawaA,KadonosonoK.Sutureless27gaugeneedleguided
intrascleralintraocularlensimplantationwithlamellarscleraldissection.Ophthalmology.
2014Jan.121(1):616.[Medline].
15.BourkeRD,GrayPJ,RosenPH,CoolingRJ.Retinaldetachmentcomplicatingscleral
suturedposteriorchamberintraocularlenssurgery.Eye.1996.10(Pt4):5018.[Medline].
16.CampoRV,ChungKD,OyakawaRT.Parsplanavitrectomyinthemanagementofdislocated
posteriorchamberlenses.AmJOphthalmol.1989Nov15.108(5):52934.[Medline].
17.ChanCK.Animprovedtechniqueformanagementofdislocatedposteriorchamberimplants.
Ophthalmology.1992Jan.99(1):517.[Medline].
18.ChanCK,AgarwalA,AgarwalS,AgarwalA.Managementofdislocatedintraocularimplants.
OphthalmolClinNorthAm.2001Dec.14(4):68193.[Medline].
http://emedicine.medscape.com/article/1211310overview 3/7
3/13/2017 IntraocularLensDislocation:Background,Pathophysiology,Epidemiology
19.DuffeyRJ,HollandEJ,AgapitosPJ,LindstromRL.Anatomicstudyoftranssclerallysutured
intraocularlensimplantation.AmJOphthalmol.1989Sep15.108(3):3009.[Medline].
20.FlynnHWJr.Parsplanavitrectomyinthemanagementofsubluxedandposteriorly
dislocatedintraocularlenses.GraefesArchClinExpOphthalmol.1987.225(3):16972.
[Medline].
21.FrammeC,HoeraufH,RoiderJ,LaquaH.Delayedintraocularlensdislocationafter
neodymium:YAGcapsulotomy.JCataractRefractSurg.1998Nov.24(11):15413.[Medline].
22.GonzalezGA,IrvineAR.Posteriordislocationofplatehapticsiliconelenses.Arch
Ophthalmol.1996Jun.114(6):7756.[Medline].
23.HayashiK,HirataA,HayashiH.Possiblepredisposingfactorsforinthebagandoutofthe
bagintraocularlensdislocationandoutcomesofintraocularlensexchangesurgery.
Ophthalmology.2007May.114(5):96975.[Medline].
24.HeilskovT,JoondephBC,OlsenKR,BlankenshipGW.Lateendophthalmitisafter
transscleralfixationofaposteriorchamberintraocularlens.ArchOphthalmol.1989Oct.
107(10):1427.[Medline].
25.JooCK,ShinJA,KimJH.Capsularopeningcontractionaftercontinuouscurvilinear
capsulorhexisandintraocularlensimplantation.JCataractRefractSurg.1996Jun.
22(5):58590.[Medline].
26.KokameGT,YamamotoI,MandelH.Scleralfixationofdislocatedposteriorchamber
intraocularlenses:Temporaryhapticexternalizationthroughaclearcornealincision.J
CataractRefractSurg.2004May.30(5):104956.[Medline].
27.LanzettaP,MenchiniU,VirgiliG,CrovatoS,RapizziE.Scleralfixatedintraocularlenses:an
angiographicstudy.Retina.1998.18(6):51520.[Medline].
28.LewisH,SanchezG.Theuseofperfluorocarbonliquidsintherepositioningofposteriorly
dislocatedintraocularlenses.Ophthalmology.1993Jul.100(7):10559.[Medline].
29.LubniewskiAJ,HollandEJ,VanMeterWS,GusslerD,ParelmanJ,SmithME.Histologic
studyofeyeswithtranssclerallysuturedposteriorchamberintraocularlenses.AmJ
Ophthalmol.1990Sep15.110(3):23743.[Medline].
30.MaguireAM,BlumenkranzMS,WardTG,WinkelmanJZ.Scleralloopfixationforposteriorly
dislocatedintraocularlenses.Operativetechniqueandlongtermresults.ArchOphthalmol.
1991Dec.109(12):17548.[Medline].
31.MalbranES,MalbranEJr,NegriI.Lensguidesuturefortransportandfixationinsecondary
IOLimplantationafterintracapsularextraction.IntOphthalmol.1986May.9(23):15160.
[Medline].
32.MarquesFF,MarquesDM,OsherRH,FreitasLL.Longitudinalstudyofintraocularlens
exchange.JCataractRefractSurg.2007Feb.33(2):2547.[Medline].
33.MittraRA,ConnorTB,HanDP,KoenigSB,MielerWF,PulidoJS.Removalofdislocated
intraocularlensesusingparsplanavitrectomywithplacementofanopenloop,flexible
anteriorchamberlens.Ophthalmology.1998Jun.105(6):10114.[Medline].
34.PorYM,CheeSP.Posteriorassistedlevitation:outcomesintheretrievalofnuclear
fragmentsandsubluxatedintraocularlenses.JCataractRefractSurg.2006Dec.
32(12):20603.[Medline].
http://emedicine.medscape.com/article/1211310overview 4/7
3/13/2017 IntraocularLensDislocation:Background,Pathophysiology,Epidemiology
35.RuizMorenoJM.Repositioningdislocatedposteriorchamberintraocularlenses.Retina.
1998.18(4):3304.[Medline].
36.SchecterRJ.Suturewickendophthalmitiswithsuturedposteriorchamberintraocularlens.J
CataractRefractSurg.1990.16:175556.
37.SchneidermanTE,JohnsonMW,SmiddyWE,FlynnHWJr,BennettSR,CantrillHL.Surgical
managementofposteriorlydislocatedsiliconeplatehapticintraocularlenses.AmJ
Ophthalmol.1997May.123(5):62935.[Medline].
38.SmiddyWE.Managementofdislocatedfoldableintraocularlenses.Retina.2005JulAug.
25(5):57680.[Medline].
39.SmiddyWE.Modificationofscleralsuturefixationtechniquefordislocatedposteriorchamber
intraocularlensimplants.ArchOphthalmol.1998Jul.116(7):967.[Medline].
40.SmiddyWE,FlynnHWJr.Managementofdislocatedposteriorchamberintraocularlenses.
Ophthalmology.1991Jun.98(6):88994.[Medline].
41.SmiddyWE,FlynnHWJr.Needleassistedscleralfixationsuturetechniqueforrelocating
posteriorlydislocatedIOLs.ArchOphthalmol.1993Feb.111(2):1612.[Medline].
42.SmiddyWE,IbanezGV,AlfonsoE,FlynnHWJr.Surgicalmanagementofdislocated
intraocularlenses.JCataractRefractSurg.1995Jan.21(1):649.[Medline].
43.SolomonK,GusslerJR,GusslerC,VanMeterWS.Incidenceandmanagementof
complicationsoftranssclerallysuturedposteriorchamberlenses.JCataractRefractSurg.
1993Jul.19(4):48893.[Medline].
44.SteinmetzRL,BrooksHL,NewellCK.Managementofposteriorlydislocatedposterior
chamberintraocularlensesbyvitrectomyandparsplanaremoval.Retina.2004Aug.
24(4):5569.[Medline].
45.TuftSJ,TalksSJ.DelayeddislocationoffoldableplatehapticsiliconelensesafterNd:YAG
laseranteriorcapsulotomy.AmJOphthalmol.1998Oct.126(4):5868.[Medline].
46.WilliamsDF,DelPieroEJ,FerronePJ,JaffeGJ,McDonaldHR,PetersMA.Managementof
complicationsineyescontainingtwointraocularlenses.Ophthalmology.1998Nov.
105(11):201722.[Medline].
MediaGallery
of0
Tables
BacktoList
ContributorInformationandDisclosures
Author
LihtehWu,MDOphthalmologist,CostaRicaVitreoandRetinaMacularAssociates
LihtehWu,MDisamemberofthefollowingmedicalsocieties:AmericanAcademyof
http://emedicine.medscape.com/article/1211310overview 5/7
3/13/2017 IntraocularLensDislocation:Background,Pathophysiology,Epidemiology
Ophthalmology,AmericanSocietyofRetinaSpecialists,AssociationforResearchinVisionand
Ophthalmology,ClubJulesGonin,MaculaSociety,PanAmericanAssociationofOphthalmology,
RetinaSociety
Disclosure:Receivedincomeinanamountequaltoorgreaterthan$250from:BayerHealth
QuantelMedicalHeidelbergEngineeringNovartis.
Coauthor(s)
RafaelAlbertoGarca,MD
Disclosure:Nothingtodisclose.
RobertHGraham,MDConsultant,DepartmentofOphthalmology,MayoClinic,Scottsdale,
Arizona
RobertHGraham,MDisamemberofthefollowingmedicalsocieties:AmericanAcademyof
Ophthalmology,ArizonaOphthalmologicalSociety,AmericanMedicalAssociation
Disclosure:PartnerreceivedsalaryfromMedscape/WebMDforemployment.
SpecialtyEditorBoard
SimonKLaw,MD,PharmDClinicalProfessorofHealthSciences,DepartmentofOphthalmology,
JulesSteinEyeInstitute,UniversityofCalifornia,LosAngeles,DavidGeffenSchoolofMedicine
SimonKLaw,MD,PharmDisamemberofthefollowingmedicalsocieties:AmericanAcademyof
Ophthalmology,AssociationforResearchinVisionandOphthalmology,AmericanGlaucoma
Society
Disclosure:Nothingtodisclose.
SteveCharles,MDDirectorofCharlesRetinaInstituteClinicalProfessor,Departmentof
Ophthalmology,UniversityofTennesseeCollegeofMedicine
SteveCharles,MDisamemberofthefollowingmedicalsocieties:AmericanAcademyof
Ophthalmology,AmericanSocietyofRetinaSpecialists,MaculaSociety,RetinaSociety,Club
JulesGonin
Disclosure:Receivedroyaltyandconsultingfeesfor:AlconLaboratories.
ChiefEditor
HamptonRoy,Sr,MDAssociateClinicalProfessor,DepartmentofOphthalmology,Universityof
ArkansasforMedicalSciences
HamptonRoy,Sr,MDisamemberofthefollowingmedicalsocieties:AmericanAcademyof
Ophthalmology,AmericanCollegeofSurgeons,PanAmericanAssociationofOphthalmology
Disclosure:Nothingtodisclose.
AdditionalContributors
BrianAPhillpotts,MD,MD
BrianAPhillpotts,MD,MDisamemberofthefollowingmedicalsocieties:AmericanAcademyof
Ophthalmology,AmericanDiabetesAssociation,AmericanMedicalAssociation,NationalMedical
Association
http://emedicine.medscape.com/article/1211310overview 6/7
3/13/2017 IntraocularLensDislocation:Background,Pathophysiology,Epidemiology
Disclosure:Nothingtodisclose.
Acknowledgements
TeodoroEvans,MDConsultingSurgeon,VitreoRetinalSection,ClinicadeOjos,CostaRica
Disclosure:Nothingtodisclose.
http://emedicine.medscape.com/article/1211310overview 7/7