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Vitrectomy for dislocated lenses

Ivan Fiser, Zdenek Dominek

Prague,Czech Repub

The purpose of our study was to evaluate the results of surgery for various types of posterior lens dislocation. We performed a retrospective chart review of 150 patients who had a surgical management of posteriorly dislocated lenses at our clinic during the 6-year period from January 1996 to March 2002.
Our group was rather heterogenic as it included dislocated lenses of all kinds: iatrogenic dislocation of nucleus fragments during cataract surgery , dropped intraocular lenses during surgery, lenses luxated due to trauma, IOLs dropped due to trauma and congenital subluxation or luxation of the lens.
The most frequent cause of iatrogenic nucleus or the IOL dislocation was the phaco procedure, less often the lens dropped into the vitreous during the ECCE and rarely during the I/A, secondary IOL insertion, after scleral fixation of the IOL and even during the PKP.
We found quite frequent complications in the preoperative finding, especially glaucoma, corneal edema, uveitis, retinal detachment and rarely other complications as choroidal hemorrhage, megalocornea, iridoplegia, fibrous membrane on the posterior surface of the IOL, penetrating injury, vitreous hemorrhage, hypotony, corneal opacification, high myopia, Marfan´s syndrome and fere absolute glaucoma. These complications of course influenced the preoperative visual acuity and often the final results, too.
Dislocated soft nuclei and lenses were removed using the vitrectomy cutter. For hard nuclei we used phacofragmentation using the routine phaco tip. In the first cases only we used PFC liquids but we stopped using them several years ago. Dropped IOLs were removed using the vitreous forceps. Rarely, it was possible to reposition the IOL into the ciliary sulcus using the vitreous forceps.
In some cases, the PC or AC IOL was implanted at the end of vitrectomy, in other cases the IOL was implanted in another procedure. Many patients were left aphakic for complications including retinal detachment, retinal tears, severe retinal degeneration, iridoplegia, PKP, high myopia, megalocornea, glaucomatous atrophy of the optic disc or for other reasons.
Noticeable complications after the surgery included elevated IOP, glaucoma, retinal detachment, corneal decompensation, reccurrent uveitis and endophthalmitis.
The reasons for poor final visual acuity were retinal detachment, various retinal degenerations, including high myopia, diabetic retinopathy, AMD etc., decompensation of glaucoma, corneal decompensation, uveitis, IOL dislocation, iridoplegia and one enucleation for dramatic endophthalmitis.
Conclusion: Vitrectomy for dislocated lenses of various origin can help many patients in preserving useful vision. Complications resulting mainly from the original cause of dislocation are frequent. Less than half of cases can be considered as uncomplicated which reflects in IOL implantation and only about half of patients ended up with reading vision. All kinds of lens dislocation should be considered as a serious state and managed in highly specialised vitreoretinal centres.
Cataract sugeons might be surprised with relatively poor functional results. We must realize, however, that this group includes many complex cases of lens dislocation combined with trauma, retinal detachment or other serious diseases.