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Edmund Tsui, Nitish Mehta, Suruchi Bhardwaj, Joseph Tseng, Kenneth Wald; Indications and outcomes of iris suture fixation for dislocated posterior chamber intraocular lenses. Invest. Ophthalmol. Vis. Sci. 2016;57(12):1063.
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© ARVO (1962-2015); The Authors (2016-present)
The optimal management of dislocated posterior chamber intraocular lenses (PCIOLs) remains undetermined. We describe our experience and clinical outcomes using iris suture fixation for dislocated PCIOLs.
A retrospective chart review was performed of all patients who underwent iris suture fixation of a dislocated PCIOL and 25-gauge pars plana vitrectomy between January 2013 and October 2015 by a single surgeon. All patients with less than 30 days of follow-up were excluded. Age, gender, pre- and post-operative best-corrected visual acuity (BCVA), time from prior cataract surgery, co-morbidities, etiology of lens dislocation, and post-operative complications were analyzed. Two tailed Student’s t-test was used for statistical analysis.
76 eyes of 74 patients were evaluated (50.0% male, 50.0% female) with mean age at initial presentation of 71.9±13.8 years. Mean time from prior cataract surgery to initial presentation was 5.37 years (range 1 day to 35 years). Mean post-operative follow-up time was 6.1 months (range 1 to 31 months). The primary etiology of lens dislocation was: recent cataract surgery (22/76, 28.9%), zonular instability (pseudoexfoliation; 21/76, 27.6%), unknown (26/76, 34.2%), trauma (5/76, 6.6%), and post-YAG capsulotomy (2/76, 2.6%). Mean best-corrected logMAR visual acuity improved from 1.10 (Snellen equivalent ~20/252) pre-operatively to 0.51 (Snellen equivalent ~ 20/65) post-operatively (p<0.0001). Post-operative complications included the following: elevated intraocular pressure requiring pressure-lowering medication (6/76, 7.9%), corneal edema (3/76, 3.9%), cystoid macular edema (4/76, 5.3%), retinal detachment (1/76, 1.3%), vitreous hemorrhage (1/76, 1.3%), and re-dislocation of intraocular lens (1/76, 1.3%). Cystoid macular edema developed at a mean of 2.8 months post-operatively. The single case with retinal detachment had retinal holes that received laser retinopexy pre- and intra-operatively. The single case of vitreous hemorrhage developed 8 months postoperatively, with no clear etiology and spontaneous resolution.
Iris suture fixation is an excellent option for repositioning of dislocated PCIOLs, resulting in stable IOL fixation, significant improvement in BCVA, and low complication rates.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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