Wan-Soo Kim 1 , Chang-Kyu Lee 2 , Jung Hyun Jang 2 Haeundae Paik Hospital Inje university 1 Maryknoll Medical Center 2

1. Possible Predisposing Factors for In-the-bag Dislocation of Intraocular Lens and Surgical Outcomes of Reposition or Exchange of Dislocated Intraocular Lens Wan-Soo Kim1, Chang-Kyu Lee2, Jung Hyun Jang2 Haeundae Paik Hospital Inje university1 Maryknoll Medical Center2 The authors have no financial interest in the subject matter of this poster

2. Subject • To examine the possible predisposing factors for intraocular lens(IOL) dislocation within the capsular bag(in-the-bag dislocation) and to study surgical outcomes of reposition or exchange of IOLs • Design : Retrospective interventional case series • Statistical analysis method • Relative risk • T-test • Significance : P-value < 0.05

3. Patient Demographics Table 1. Patient Demographics (Mean ± SD) † Cases that didn’t occur late onset complications of In-the-bag dislocation of IOL managed at the Maryknoll Medical Center in 2008 * At time of intraocular lens exchange or reposition surgery ‡ From cataract surgery tovisual disturbance symptom onset

4. Outcome index Preoperative index IOL type 1-piece PMMA 3-piece PMMA 3-piece acrylic 3-piece silicone Nd:YAG capsulotomy Presence, interval Postoperative index Surgical intervention Best corrected visual acuity IOP Spherical equivalent Refractive astigmatism • Predisposing conditions • Pseudoexfoliation syndrome • Trauma History • Ophthalmologic underlying disease • Previous vitreoretinal surgery • Surgical trauma • High myopia (Axial length) • Other zonular dehiscence factors

5. Result • IOL type † At time of intraocular lens exchange or reposition surgery Figure 1. Types of dislocated IOL

6. Nd-YAG capsulotomy • 2 case(5.1%) • Interval (procedure to dislocation) : 4.3 ± 3.4 mo. • Surgical intervention • IOL exchange / reposition : 15 / 23 case • 1 point / 2 point scleral fixation : 5 / 33 case • Other : 1 case • (Aphakic state in the case of pathologic myopia)

7. Surgical outcome Table 2. Surgical outcomes (Mean ± SD) *Analasized by T-test

8. IOL Exchange vs Reposition Fig. 3 Intraocular pressure Fig. 2 Best corrected visual acuity Fig. 4 Corneal astigmatism

9. Predisposing Factors Table 3. Predisposing Factors

10. Vitreoretinal surgery • 3case : Scleral buckling d/t RRD • Axial length • 25.32mm (±2.46) • 1 case : pathologic myopia, 34.76mm • Surgical trauma • Iatrogenic radial tear and zonular dialysis during the cataract surgery

11. Relative risk (Case/%) Table 4. Relative risk

12. Discussion • Possible major predisposing factor for in-the-bag IOL dislocation are Pseudoexfolication, retinal pigmentosa, the status after vitrectomy and trauma - Ken Hayashi, Akira Hirata, Hideyuki Hayashi, 2007 by the AAO • Pseudoexfoliation, uveitis, myopia, and other diseases associated progressive zonular weakening and capsular contraction are the predisposing factor of in-the-bag IOL dislocation - Howard V. Gimbel, MPH, Garry P. Condon, Thomas Kohnen, Randall J. Olson, Ioannis Halkiadakis, JCRS 2005 • Sufficiency time is necessary • For considering predisposing factors of dislocation • For clinical manifestations • Surgeons have to • Use techniques thought to be least traumatic to the zonule • describe zonular dehiscence during the surgery if it occurs