3/13/2017 Intraocular Lens Dislocation: Background, Pathophysiology, Epidemiology

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Intraocular Lens Dislocation

Updated: Sep 29, 2015
Author: Lihteh Wu, MD Chief Editor: Hampton Roy, Sr, MD more...

OVERVIEW

Background
Cataract surgery is the most common operation performed by ophthalmologists. Although it has a
very high success rate, certain complications may occur. Intraocular lens (IOL) malpositions range
from simple IOL decentration to luxation into the posterior segment. Subluxated IOLs involve such
extreme decentration that the IOL optic covers only a small fraction of the pupillary space. Luxation
involves total dislocation of the IOL into the posterior segment. Decentration of an IOL may be the
result of the original surgical placement of the lens, or it may develop in the postoperative period
because of external (eg, trauma, eye rubbing) or internal forces (eg, scarring, peripheral anterior
synechiae [PAS], capsular contraction, size disparity). Posterior dislocation of an intraocular lens
(IOL) is an uncommon complication of cataract surgery and Nd:YAG posterior capsulotomy.
See What the Eyes Tell You: 16 Abnormalities of the Lens, a Critical Images slideshow, to help
recognize lens abnormalities that are clues to various conditions and diseases.

Pathophysiology
IOL dislocation can be subdivided into early and late dislocation. Early dislocation refers to
dislocation occurring within 3 months of cataract surgery, whereas late dislocation occurs more
[1]
than 3 months after cataract extraction.
Posterior dislocation of an IOL may occur during or shortly after cataract surgery. In these cases,
posterior capsular rupture or zonular dialysis usually is present. It occurs because of improper
[2]
fixation within the capsular bag and instability of the IOLcapsular bag complex. The
implementation of a continuous curvilinear capsulorrhexis (CCC) during phacoemulsification has
[3]
decreased the rate of early IOL dislocation. CCC gives support to the IOL optic for 360 degrees
and permits excellent IOL fixation. Prior to CCC, most IOL dislocation occurred secondary to
asymmetric IOL fixation or IOL malposition within the capsular bag. Rarely, it may occur following
Nd:YAG capsulotomy or beyond the immediate postoperative period. Trauma may be a precipitant
in these cases.
[1, 4, 5]
Late IOL dislocation has been noted to occur more frequently than previously thought. Late IOL
dislocation results from zonular weakness since the IOL is adequately fixed within the capsular
[6]
bag. Several risk factors, including pseudoexfoliation syndrome, trauma, prior vitreoretinal
surgery, and connective tissue disorders, have been associated with zonular weakness. In a
retrospective case series of 86 late IOL dislocations, the IOL dislocated on average 8.5 years after
[1]
phacoemulsification and IOL implantation. These same authors reported that patients with any
type of IOL were at risk for late inthebag IOL dislocation. A populationbased study of patients by
Pueringer et al found that after cataract extraction, the longterm risk of late IOL dislocation was
[7]
low and had no significant change over the almost 30year study period.

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The IOL rarely dislocates completely onto the retinal surface. It usually lies meshed into the
anterior vitreous with one haptic still adherent to the capsule or iris. It may cause a vitreous
hemorrhage by mechanical contact with ciliary body vessels. The IOL may be related to retinal
detachment or cystoid macular edema secondary to vitreous changes and may cause pupillary
block or corneal contact with secondary corneal edema. On many occasions, it does not cause any
complications and may be left alone if the patient is able to use aphakic spectacles or contact
lenses.

Epidemiology
Frequency
United States

Clinically insignificant decentration occurs in at least 25% of cases. Clinically significant

decentration occurs in about 3% of the cases. The frequency of IOL dislocation ranges from 0.2
1.8%. The rate is lower in eyes with posterior chamber IOLs (PCIOL) than with anterior chamber
IOLs (ACIOL) or irissupported lenses. However, since posterior chamber IOLs constitute most
lenses implanted, decentered and dislocated posterior chamber IOLs have become more
prevalent.
The frequency appears to have increased in the past few years because of the following reasons:
(1) phacoemulsification has a steep learning curve, and, as it becomes more popular, more
complications are occurring (2) anterior segment surgeons are becoming more reluctant to place
anterior chamber intraocular lenses (ACIOLs) (3) aggressive placement of posterior chamber IOL
in the presence of capsular tears has become more common and (4) silicone plate IOLs have
become popular.
A longitudinal study reported that, in 85% of posterior chamber IOL exchange cases, the indication
was decentration/dislocation of the lens.

Race

Pseudoexfoliation syndrome, by virtue of its weakening effect on the zonules, is one of the most
[1]
common conditions associated with late IOL dislocation. The pseudoexfoliation syndrome
is commonly seen in people with Scandinavian heritage.

Sex

No gender preference exists in IOL dislocation.

Age

Age is not related to this condition.

Clinical Presentation

References

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Contributor Information and Disclosures

Author

Lihteh Wu, MD Ophthalmologist, Costa Rica Vitreo and Retina Macular Associates

Lihteh Wu, MD is a member of the following medical societies: American Academy of

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Ophthalmology, American Society of Retina Specialists, Association for Research in Vision and
Ophthalmology, Club Jules Gonin, Macula Society, PanAmerican Association of Ophthalmology,
Retina Society

Disclosure: Received income in an amount equal to or greater than $250 from: Bayer Health
Quantel Medical Heidelberg Engineering Novartis.
Coauthor(s)

Rafael Alberto Garca, MD

Disclosure: Nothing to disclose.

Robert H Graham, MD Consultant, Department of Ophthalmology, Mayo Clinic, Scottsdale,

Arizona

Robert H Graham, MD is a member of the following medical societies: American Academy of

Ophthalmology, Arizona Ophthalmological Society, American Medical Association

Disclosure: Partner received salary from Medscape/WebMD for employment.

Specialty Editor Board

Simon K Law, MD, PharmD Clinical Professor of Health Sciences, Department of Ophthalmology,
Jules Stein Eye Institute, University of California, Los Angeles, David Geffen School of Medicine

Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of
Ophthalmology, Association for Research in Vision and Ophthalmology, American Glaucoma
Society

Disclosure: Nothing to disclose.

Steve Charles, MD Director of Charles Retina Institute Clinical Professor, Department of

Ophthalmology, University of Tennessee College of Medicine

Steve Charles, MD is a member of the following medical societies: American Academy of

Ophthalmology, American Society of Retina Specialists, Macula Society, Retina Society, Club
Jules Gonin

Disclosure: Received royalty and consulting fees for: Alcon Laboratories.

Chief Editor

Hampton Roy, Sr, MD Associate Clinical Professor, Department of Ophthalmology, University of

Arkansas for Medical Sciences

Hampton Roy, Sr, MD is a member of the following medical societies: American Academy of
Ophthalmology, American College of Surgeons, PanAmerican Association of Ophthalmology

Disclosure: Nothing to disclose.

Additional Contributors

Brian A Phillpotts, MD, MD

Brian A Phillpotts, MD, MD is a member of the following medical societies: American Academy of
Ophthalmology, American Diabetes Association, American Medical Association, National Medical
Association

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Disclosure: Nothing to disclose.

Acknowledgements

Teodoro Evans, MD Consulting Surgeon, VitreoRetinal Section, Clinica de Ojos, Costa Rica

Disclosure: Nothing to disclose.

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