Eyeworld

20 | EYEWORLD | DECEMBER 2021 ASCRS NEWS References 1. Monestam E. Frequency of intraocular lens dislocation and pseudophacodonesis, 20 years after cataract surgery—a pro- spective study. Am J Ophthalmol. 2019;198:215–222. 2. Kristianslund O, et al. Late in-the-bag intraocular lens dislo- cation: a randomized clinical trial comparing lens repositioning and lens exchange. Ophthalmology. 2017;124:151–159. 3. Dabrowska-Kloda K, et al. Incidence and risk factors of late in-the-bag intraocular lens dislocation: evaluation of 140 eyes between 1992 and 2012. J Cataract Refract Surg. 2015;41:1376–1382. 4. Durr GM, Ahmed IIK. Intraocu- lar lens complications: decentra- tion, uveitis-glaucoma-hyphema syndrome, opacification, and refractive surprises. Ophthalmolo- gy. 2020. Online ahead of print. 5. Dalby M, et al. Repositioning surgery of different intraocular lens designs in eyes with late in-the-bag intraocular lens dis- location. J Cataract Refract Surg. 2021;47:1147–1152. 6. Samuelson TW. Managing an unstable subluxated intraocular lens with uncontrolled intraocular pressure and progressing glauco- ma: July consultation #1. J Cataract Refract Surg. 2016;42:1098–1099. 7. Ahmed IIK, Snyder ME. Man- agement of dislocated intraocular lenses: Clinicians' Corner. Ameri- can Academy of Ophthalmology. 8. Zhang L, et al. Mechanisms for in-the-bag uveitis-glaucoma-hy- phema syndrome. J Cataract Refract Surg. 2014;40:490–492. 9. Boutboul S, et al. Pigmentary glaucoma secondary to in-the- bag intraocular lens implan- tation. J Cataract Refract Surg. 2008;34:1595–1597. 10. Price MO, et al. Late dislocation of scleral-sutured posterior cham- ber intraocular lenses. J Cataract Refract Surg. 2005;31:1320–1326. to potential for UGH syndrome. UGH syndrome can be caused by any IOL in the sulcus 4 and even in the capsular bag with possible causes in- cluding a deformed haptic, out-of-the bag dislo- cation of the IOL or haptic, Soemmering's ring, or pseudophacodonesis. 8,9 This study suggests a similar safety profile between 1-piece IOL de- signs and 3-piece IOL designs with no instances of UGH syndrome. In the study, potential causes of UGH are addressed both preop by excluding any out-of-the bag dislocations and intraopera- tively by using a surgical technique that secures the IOL with scleral sutures and thus should eliminate pseudophacodonesis. It is also noted that while CDVA was similar between the two IOL design groups, the postop change in spherical equivalent was –0.98 D for the 3-piece IOL group compared to –0.08 D for the 1-piece IOL group. This may be due to dif- ferences in the biomechanics of the IOLs as well as differences in haptic thickness and angle. This suggests that for repositioning of 3-piece IOLs, more posterior placement of the scleral su- tures may be considered to avoid the associated relative myopic shift. Some limitations of this study include an analysis that is limited to comparing only the 1-piece and 3-piece foldable IOL designs, primarily because of insufficient power due to a low number of eyes with other IOL designs. While foldable 1-piece and 3-piece designs are the most common designs used during CEIOL, future studies comparing more IOL designs and materials would be beneficial. In addition, all cases were performed by a single surgeon using a singular technique. While this technique was found to be relatively safe in terms of outcomes, it would be beneficial to compare this technique with others, such as Yamane, as well as other scleral suturing techniques with and without scleral flaps. Another discussion point brought up during the ASCRS Journal Club was the use of 10-0 polypropylene sutures compared to 9-0 polypro- pylene or 8-0 Gore-Tex sutures. Given evidence of late dislocations of scleral-sutured PCIOL due to degradation of suture material over time, the use of larger diameter than 10-0 polypropylene suture material as well as placement of haptic and sutures in the ciliary sulcus may promote attachment of scar tissue and enhance long- term stability of scleral-fixated IOLs. 10 Repositioning surgery of different intraocular lens designs in eyes with late in-the-bag intraocular lens dislocation Marius Dalby, MD, Liv Drolsum, MD, Olav Kristianslund, MD J Cataract Refract Surg. 2021;47(9):1147–1152. n Purpose: To evaluate the long-term efficacy and safety after intraocular lens (IOL) repositioning by scleral suturing of 1-piece IOL compared with other IOL designs in the treatment of late in-the-bag IOL dislocation. n Setting: Patients referred to Oslo University Hospital. n Design: Prospective cohort study. n Methods: The study comprised 54 patients (54 eyes) with late in-the-bag IOL dislocation treated with IOL repositioning by scleral sutures (10-0 polypropylene). All operations were performed with an anterior approach and by one surgeon. The following IOL designs were repositioned: 1-piece foldable (n=17), 3-piece foldable (n=28), plate haptic (n=8), and 1-piece rigid (n=1). Patients were evaluated comprehensively before surgery, and 6 months (80%), 1 year (67%), and 2 years (61%) after surgery. The main outcome measures were efficacy in terms of corrected distance visual acuity (CDVA) and spherical equivalent (SE), and safety in terms of complications. n Results: Postoperative visual acuity was similar for different IOL designs. Mean SE change to final observation was –0.08 (95% CI, –0.93, 0.77) in the 1-piece group and –0.98 (–1.73, –0.23) in the 3-piece group (P=.11). In terms of safety, no patients had uveitis-glaucoma-hyphema syndrome, retinal detachment, or endophthalmitis. The 3-piece group had 1 case of redislocation and 1 case of iritis. No patients had symptoms related to clinical IOL decentration. Long-term intraocular pressure remained within normal limits with overlapping 95% CIs for different IOLs. n Conclusions: Repositioning surgery of 1-piece IOLs appears as efficient and safe as that for other IOL designs in the treatment of late in-the-bag IOL dislocation. continued from page 19

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