LONG-TERM RESULTS AFTER REMOVAL OF DISLOCATED INTRAOCULAR LENSES FROMTHE RETINAL SURFACE THROUGH A LIMBAL APPROACH

Background: The authors describe the use of a limbal approach for remo ving dislocated intraocular lenses (IOLs) from the retinal surface to minimize surgical trauma and optimize visual outcome. Methods: Thirtee n consecutive patients underwent removal of a dislocated posterior cha mber IOL (PC IOL) from the retinal surface through a limbal approach. The surgical technique used in all patients included a limbal incision from the 3- to 9-o'clock positions; open-sky vitrectomy, grasping the IOL at the angle between loops and optics with an iris hook; and IOL removal through the corneoscleral opening. In all except one patient, who had high-degree myopia, an IOL was re-implanted during the same su rgical procedure (free sulcus fixation of a PC IOL over remnants of th e capsular bag, 7 patients; sulcus fixation of a PC IOL over remnants of the capsular bag combined with 1 transscleral suture, 3 patients; a nd implantation of an anterior chamber IOL, 2 patients). Results: No r etinal or corneal complications secondary to IOL removal and re-implan tation through a limbal approach could be detected over an average fol low-up period of 22.3 months (range, 17-27 months). Best-corrected vis ual acuity was 20/40 or better in seven patients, between 20/50 and 20 /400 in three, and less than 20/400 in three. Visual outcome worse tha n 20/40 was related to pre-existing macular degeneration in five patie nts and retinitis pigmentosa in an additional one. Conclusions: The us e of a limbal approach allows removal of an IOL from the retinal surfa ce and secondary IOL implantation in the preferred site during the sam e surgical procedure. Because no special instrumentation is needed, th is technique also is suitable for primary removal if dislocation occur s intraoperatively. The visual outcome and the long-term absence of co mplications recorded in our series indicate that a limbal approach may offer a reasonable alternative in managing IOLs luxated onto the reti nal surface.