1 / 16

An Epidemic of Dislocated IOLs?

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.

waneta
Download Presentation

An Epidemic of Dislocated IOLs?

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. An Epidemic of Dislocated IOLs? Garth Stevens Jr. MD Eye Care Center of Virginia Mary Washington Eye Care Center

  2. Financial Disclosure The speaker is a paid consultant to Allergan, Inspire, and Abbott Medical Optics

  3. Observation • Increased incidence of IOL dislocation the last 5 years

  4. 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

  5. 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%

  6. 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??

  7. 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?

  8. Capsular phimosis as a cause of dislocation

  9. 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?

  10. Cofactors in Dislocations EARLY LATE Pseudo-exfoliation Vitreoretinal surgery Trauma Uveitis Cataract surgery complications Yag capsulotomy Capsular contraction syndrome • Capsular rupture • Capsular instability

  11. Dislocated with attached capsule Courtesy J. Astruc

  12. Iris sutured IOL 10-0 prolene

  13. Primary treatment concerns • When to intervene • Pseudo-phakodonesis • Subluxation • Dislocation • Factors • Age

  14. 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

  15. 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

More Related