Complication profiles differentiate methods for managing IOL dislocation

IOL repositioning with suturing techniques and IOL exchange forthe management of a dislocated IOL are associated with similarimprovement in visual acuity. The two approaches, however, aredistinguished by their different complication profiles, saidJoshua C. Teichman, MD, Toronto, Ontario.

Dr. Teichman presented the results of a retrospective chartreview of 306 eyes that had undergone IOL exchange (n = 162) orrepositioning (n = 144) between 1995 and 2008. Mean follow-upafter the secondary surgery was 8 months in the IOL exchangegroup and 10.6 months in the repositioning group.

No significant differences existed between the two groups inpreoperative or postoperative best-corrected visual acuity(BCVA), and both groups showed a significant and similarimprovement in BCVA.

Transient IOP rise was the most common complication in bothgroups with no significant difference between groups in theincidence of that event. As expected, significantly more woundleaks occurred in eyes undergoing IOL exchange versusrepositioning. In addition, retinal detachment (three cases,including two re-detachments) and endophthalmitis (one case)occurred only in the IOL exchange group, which was attributed tothe increased intraocular manipulations associated with theexchange procedure.

Redislocation occurred in 6.9% of eyes after IOL repositioning, arate that was significantly higher than in the exchange group,and repositioning also was associated with a 4.2% rate ofposterior capsule opacification, which was significantly higherthan in the exchange group.

"Overall the complication rate is low for both techniques," Dr.Teichman said. "Considering both IOL exchange and suturerepositioning provide similar improvement in vision, thepreferred approach needs to be individualized to the patient,based on such factors as lens position, material, andpatient-related issues."