an epidemic of dislocated iols?
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An Epidemic of Dislocated IOLs?. Garth Stevens Jr. MD Eye Care Center of Virginia Mary Washington Eye Care Center. Financial Disclosure. The speaker is a paid consultant to Allergan, Inspire, and Abbott Medical Optics. Observation. Increased incidence of IOL dislocation the last 5 years. - PowerPoint PPT PresentationTRANSCRIPT
An Epidemic of Dislocated IOLs?
Garth Stevens Jr. MD
Eye Care Center of VirginiaMary Washington Eye Care Center
Financial Disclosure
The speaker is a paid consultant to Allergan, Inspire, and Abbott Medical Optics
Observation
» Increased incidence of IOL dislocation the last 5 years
Incidence over time
Retina Institute of Virginia (379.39,996.53)
» 2006: 12» 2007: 17» 2008: 23» 2009: 22» 2010: 23
Eye Care Center of Virginia» 2000 to 2006: 14» 2007: 12» 2008: 15» 2009: 18» 2010: 15
Question: is there an increased incidence of dislocated IOLs over the last decade?
Davis et al Ophthalmology 2009, 116, 664-670.
86 cases in bag pathology specimens» 2000-2006: 27» 2006-2008: 59
Associated diagnosis» Pseudoexfoliation (PXF) 50%» Vitreo-retinal surgery 19%» Trauma 16%» Unknown 23%» Uveitis 2%
Incidence of IOL dislocation
Unclear, older reports from 1980s 0.2 to 3%, no good recent data. Certainly less than 1% with modern cataract surgery techniques
Clark .2% 10 y period others 0.6% over 10 y, with 2% with phakodonesis
How many of you have experienced in the bag dislocations, out of bag dislocations??
Role of capsular phimosis
Mechanisms» Preop zonules weak, surgery, capsular
contraction, post op trauma Exerts traction on zonules and may be
related to dislocations» Should we avoid small capsulorhexis in
high risk patients?
Capsular phimosis as a cause of dislocation
Open questions
Do capsular tension rings decrease the incidence of late dislocation of IOLs in PXF? » Probably yes with the Cionni ring and scleral
fixation
Should we ensure that capsulotomy openings are larger in PXF to avoid capsular contraction syndrome?
Cofactors in DislocationsEARLY Capsular rupture Capsular instability
LATE Pseudo-exfoliation Vitreoretinal surgery Trauma Uveitis Cataract surgery
complications Yag capsulotomy Capsular contraction
syndrome
Dislocated with attached capsule
Courtesy J. Astruc
Iris sutured IOL
10-0 prolene
Primary treatment concerns
When to intervene» Pseudo-phakodonesis» Subluxation» Dislocation
Factors» Age
Surgical decisions
Replace or reposition» Replace
– Damaged haptic– Opacified optic
» One piece PMMA IOL with suturing eyelets in haptics
» Scleral fixation with prolene or Gore-Tex sutures
Alternative» AC IOL» In bag suturing to
sclera or iris» Fibrin glue to haptics
under sclera
90 y o, 20 y after cataract surgery, 3 y after suturing of left eye, 20/400 preop, 20/40 post op, removal retained lens material