Eyeworld

JULY 2023 | EYEWORLD | 21 References 1. Mamalis N. Intraocular lens dislocation. J Cataract Refract Surg. 2013;39:973–974. 2. Gimbel HV, et al. Late in-the- bag intraocular lens dislocation: incidence, prevention, and management. J Cataract Refract Surg. 2005;31:2193–2204. 3. Georgopoulos GT, et al. Management of large traumatic zonular dialysis with phacoemul- sification and IOL implantation using the capsular tension ring. Acta Ophthalmol Scand. 2007;85:653–657. 4. Wang BZ, et al. A retrospective study of the indications and out- comes of capsular tension ring insertion during cataract surgery at a tertiary teaching hospital. Clin Ophthalmol. 2013;7:567–572. 5. Lorente R, et al. Management of late spontaneous in-the-bag intraocular lens dislocation: retrospective analysis of 45 cases. J Cataract Refract Surg. 2010;36:1270–1282. 6. Werner L, et al. In-the-bag capsular tension ring and intraocular lens subluxation or dislocation: a series of 23 cases. Ophthalmology. 2012;119:266– 271. 7. Artzen D, et al. Visual acuity and intraocular pressure after surgical management of late in-the-bag dislocation of intra- ocular lenses. A single-centre prospective study. Eye (Lond). 2020;34:1406–1412. 8. Mayer-Xanthaki CF, et al. Impact of intraocular lens characteristics on intraocular lens dislocation after cataract surgery. Br J Ophthalmol. 2021;105:1510–1514. uveitis, retinitis pigmentosa young age, and male sex were significantly associated with an ITB dislocation. Large overall IOL diameter was a protective factor according to the multivar- iate model. One hundred thirty- one eyes of 4,999 eyes with PEX had a CTR implanted. A subgroup analysis showed reduced risk of ITB dislocation for CTR use in eyes with PEX (HR, 0.16, 95% CI, 0.04–0.70; P=0.015). Of 1,103 eyes with weak zonular fibers, 542 had a CTR implantation. Using a CTR in eyes with zonular weakness offered only a potential risk reduction (HR, 0.37, 95% CI, 0.12–1.12; P=0.078). Discussion Mayer-Xanthaki et al. found that CTR implan- tation was associated with a lower risk of late ITB dislocation. Due to the high prevalence of PEX and its known association as a predisposing risk factor, a subgroup analysis for patients with PEX was performed. This subgroup analysis demonstrated CTR implantation was protective against ITB dislocation in eyes with PEX but not for eyes without PEX. CTR implantation was postoperative referrals due to IOL dislocations in this time period. ITB dislocation of interest in this study was defined as IOL-capsular bag complex luxation after uncomplicated cataract surgery and IOL implantation. The extracted dataset comprised variables including sex, age, technique of cataract surgery, the operated eye, zonular fiber weakness in surgery, non-sutured CTR insertion during surgery, anterior capsule staining with trypan blue, and noted time to IOL dislocation. Previously reported possible risk factors for IOL dislocation, including pseudoex- foliation (PEX), axial length ≥25.5 mm, uveitis, ocular trauma, and retinitis pigmentosa, were also identified. Cases of intracapsular extraction, intraoperative posterior capsular rupture, com- bined phacoemulsification and vitrectomy, and IOL dislocations referred from other institutions were excluded. Descriptive statistics included medians and range for the metric variables, and absolute and relative frequencies for the categorical variables. Exploratory univariate and multivariate Cox proportional hazards regres- sion analyses were employed for risk factors and hazard ratios (with determination of 95% con- fidence intervals), with follow-up time defined as last follow-up noted in the record, date of presentation with IOL dislocation, or estimated life expectancy from the time of surgery (deter- mined based on annual Austrian national census data). The statistical significance threshold was set at a P value of 0.05. Results A total of 68,199 eyes were included in the analysis. Median age at the time of surgery was 76 years. 60.2% of the surgeries were performed in women. Phacoemulsification was performed in 65,143 (95.5%) eyes and extracapsular cataract extraction with manual extraction of the nucleus in 3,056 (4.5%) eyes. One hundred and eleven (0.16%) ITB disloca- tions were registered. The median number of years between the cataract surgery and the ITB dislocation was 6.8 (range 0.1 to 18.8). For dis- locations with and without a CTR, the median number of years was 4.3 (0.4 to 14.9) and 7.0 (0.1 to 18.8), respectively. In the univariable Cox regression analysis and multivariate model, CTR, PEX, weak zonular fibers, continued on page 22 While some studies support the protective effects of CTRs, others suggest CTRs may lead to earlier and more frequent ITB dislocations. Therefore, Mayer-Xanthaki et al. sought to further characterize the impact of CTR implantation on the development of ITB dislocations.

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