Eyeworld

18 | EYEWORLD | DECEMBER 2021 Review of "Repositioning surgery of different intraocular lens designs in eyes with late in-the-bag intraocular lens dislocation" Contact Parra: ASParra@mednet.ucla.edu Pineles: pineles@jsei.ucla.edu by Andres Parra, MD ASCRS NEWS Andres Parra, MD PGY4 Resident Stein Eye Institute David Geffen School of Medicine University of California, Los Angeles Los Angeles, California Stacy Pineles, MD Residency Program Director Stein Eye Institute David Geffen School of Medicine University of California, Los Angeles Los Angeles, California The ASCRS Journal Club is a virtual, compli- mentary CME offering exclusive to ASCRS members that brings the experience of a lively discussion of two current articles from the Journal of Cataract & Refractive Surgery to the viewer. Co-moderated by Nick Mamalis, MD, and Leela Raju, MD, the September session featured a presentation by Jeremy Kieval, MD, author of "Prevention and management of refractive prediction errors following cataract surgery." The second manuscript, "Repositioning surgery of differ- ent intraocular lens designs in eyes with late in-the-bag intraocular lens dislocation," was presented by Andres Parra, MD, resident, Stein Eye Institute, University of California, Los Angeles. To view the September Journal Club session, go to ascrs.org/clinical- education/journal-club/schedule/ september-2021. ASCRS/EYEWORLD JOURNAL CLUB F ollowing cataract extraction with IOL implantation, late in-the-bag IOL dislo- cation is a known phenomenon with an estimated incidence of 0.5–1%. 1,2 This type of IOL dislocation occurs on average 6–12 years after otherwise uneventful cataract surgery, and risk factors include pseudoexfolia- tion, trauma, high myopia, vitreoretinal surgery, and uveitis. 1–4 The decision to pursue surgery to address this dislocation is based off a myriad of factors including whether the patient experienc- es visual symptoms subjectively, the degree of dislocation of the IOL, as well as presumed risk of further dislocation. 5 Surgical approaches can include IOL repositioning by various techniques or IOL exchange. Existing literature raises con- cerns regarding the suitability of using 1-piece IOLs in repositioning, primarily due to potential for uveitis-glaucoma-hyphema (UGH) syndrome due to iris chafing. 6,7 However, the authors of this study hypothesized that if IOL dislocation occurs in the bag and repositioning surgery techniques maintain the IOL in the bag, there should be a similar safety profile for the 1-piece IOL when compared to the 3-piece IOL design. Design and methods This prospective cohort study aimed to evaluate the long-term efficacy and safety following IOL repositioning of varying IOL designs for late in- the-bag dislocations. The IOL designs includ- ed 1-piece foldable (n=17), 3-piece foldable (n=28), plate haptic (n=8), and 1-piece rigid (n=1). The surgical technique employed scleral suturing via anterior approach using an ab externo suture loop technique with two scleral fixation points 180 degrees apart and placed approximately 1.8–2.0 mm behind the limbus using two 10-0 polypropylene sutures. All sur- geries were performed by one surgeon. Extensive preop screening took place to en- sure all dislocations were exclusively in the bag and no dislocation was found to be out of the bag. Patients were examined postop as well as at the 6-month, 1-year, and 2-year postop marks by the same ophthalmologists. The primary outcome of safety was determined as the ab- sence of postop UGH syndrome or redislocation, however, the examination also tracked other complications such as iritis, IOP changes, and clinically relevant IOL decentration. The other primary outcome was efficacy in terms of post- op corrected distance visual acuity (CDVA) and postop change in spherical equivalent. Postop spherical equivalent was compared to habitual refraction prior to IOL dislocation to determine the change in spherical equivalent. Predisposing risk factors in the population included pseudoexfoliation in 42 eyes (78%), myopia in 10 eyes (19%), previous vitreoretinal surgery in 5 eyes (9%), blunt trauma in 4 eyes (7%), and history of uveitis in 3 eyes (6%), with overlap of risk factors in some eyes and no pre- disposing risk factors in three eyes (6%). Summary of results The main analysis compared repositioning of the two most common IOL designs, the 1-piece

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