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Jason Horowitz, Sarah N Yu, Mark P Breazzano, C Gustavo De Moraes; Trends and risk factors for intraocular lens exchange and repositioning in vitreoretinal surgery. Invest. Ophthalmol. Vis. Sci. 2020;61(7):4397.
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© ARVO (1962-2015); The Authors (2016-present)
Intraocular lens (IOL) dislocation is an uncommon but serious complication after cataract surgery. This study describes the trends and indications for intraocular lens (IOL) exchange or repositioning on the vitreoretinal service.
Between January 2014 and June 2019, 2109 patients underwent vitreoretinal surgery at our institution. This is a retrospective review of 114 eyes of 114 patients who underwent concomitant IOL exchange or repositioning during vitrectomy. Indications for IOL surgery and prior ocular history were obtained. Statistical analysis employing a one-sample test of proportions was used to evaluate rate of prior vitreoretinal surgery in our cohort.
114 patients had a total of 126 IOL repositioning or exchange surgeries. Yearly rate of IOL exchange among vitreoretinal cases ranged from 4.9% to 7.0%. Causes for IOL dislocation included: spontaneous or secondary to pseudoexfoliation (n=57, 45%), prior vitreoretinal surgery (n=34, 27%), complicated cataract surgery (n=17, 14%), repeat IOL dislocation (failure of prior IOL dislocation surgery) (n=12, 9%), and trauma (n=6, 5%). The proportion of patients with a history of prior vitreoretinal surgery in our cohort (27%) is significantly higher than the upper bounds of what would be expected in a population of cataract surgery patients as a whole (6%) based on historical data (p<.0001). In our series, median duration to IOL exchange or repositioning was 8.4 (0.5-12.5) years for spontaneous dislocation and 8.1 (2.4-14.5) years in those with prior vitreoretinal surgery. Among patients with prior vitreoretinal surgery in whom the sequence of ocular surgery was known, vitrectomy was done first in 56% cases (n=14/25), and routine cataract surgery was done first in 44% (n=11/25).
Vitreoretinal surgery appears to be a clinically and statistically significant antecedent to surgery-requiring IOL dislocation. Patients may need to be counseled on the risks of this complication when undergoing vitreoretinal surgery.
This is a 2020 ARVO Annual Meeting abstract.
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