Eyeworld

EW REFRACTIVE 130 March 2018 by Stefanie Petrou Binder, MD, EyeWorld Contributing Writer placing the scleral sutures at the usual positions, a myopic shift must be expected, and therefore the risk for anisometropia should be care- fully considered when choosing this method preoperatively. IOL exchange using the retropupillary iris claw IOL had good refractive pre- dictability in 83% of patients who achieved within ±1.0 D of target refraction. Using a slightly higher A constant might provide better results. In terms of the refractive outcome, IOL exchange seems to be the favorable operation method at least when comparing these two surgical techniques." The study included 104 eyes of 104 patients with a mean age of 82 years, who were randomly assigned to either IOL repositioning using scleral sutures around each of the haptics or IOL exchange with an iris claw lens. IOL repositioning/ scleral suturing was carried out in 54 of the patients, employing an ab externo suture loop fixation tech- nique that also used scleral flaps to cover the knots. The IOL exchanges involved the placement of iris claw aphakic IOLs in 50 patients, using Choosing between IOL repositioning and replacement in the management of late IOL dislocation L ate in-the-bag IOL disloca- tion can happen around 7 to 10 years after cataract surgery and affects a small percentage of pseudophakic patients. A retrospective population based study that analyzed cataract surgeries performed between 1980 and 2009, including roughly 14,500 cataract cases, showed that the risk of late IOL dislocation after cataract surgery was low, with a cumulative risk of 0.1–1.7%, which did not significantly change over the 30-year span in question. 1 Cataract sur- geons with patients presenting with this relatively rare complication of cataract surgery may not always be aware of their best options. As there is no real consensus in the literature on how to treat cases of late in-the- bag IOL dislocation, a new study set out to help define the management Managing late in-the-bag IOL dislocation Late in-the-bag IOL dislocation After IOL repositioning surgery by scleral suture Source: Olav Kristianslund, MD continued on page 132 preferences available to cataract surgeons. An investigation group from Norway presented a randomized clinical trial at the XXXV Congress of the ESCRS, comparing IOL reposi- tioning with IOL exchange in cases of late in-the-bag IOL dislocation. According to Olav Kristianslund, MD, Department of Ophthalmolo- gy, Oslo University Hospital, Nor- way, who presented the study, the outcomes of both techniques were satisfactory and not significantly different for the primary outcome measure of BCVA at 6 months, as well as in the degree of surgically induced astigmatism. "IOL repositioning by scleral suturing was associated on average with a myopic shift, with a mean change of –0.7 D, due to a more anterior position of the IOL capsule complex," Dr. Kristianslund said. "This could possibly be avoided by placing the scleral sutures more posteriorly than in our study, which was 1.5–2 mm posterior to the limbus. However, if this results in a more unstable complex, it may not be a better option. When 5.5 mm scleral pocket incisions and IOL enclavation behind the iris. A constant 116.9 (SRK/T formula) was applied, as recommended in the literature. The same surgeon, Liv Drolsum, MD, PhD, operated on all the patients. At 6 months after surgery, the best corrected visual acuity (BCVA, logMAR) in the IOL reposition- ing group was 0.24 ± 0.29, and it was 0.35 ± 0.54 (P=.23) in the IOL exchange group. BCVA above 20/40 was noted in 26 (61%) of the IOL repositioning eyes and in 26 (62%) (P=.99) of the IOL exchange eyes. 2 IOP "We also observed that late in-the- bag IOL dislocation was closely associated with increased IOP and pseudoexfoliation glaucoma, in this study population, which we published separately. 3 Pseudoexfolia- tion syndrome has been established as an important risk factor for late in-the-bag dislocation, associated with weak zonules and contraction of the anterior capsule, which can Presentation spotlight

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