REMOVAL OF DISLOCATED INTRAOCULAR LENSES USING PARS-PLANA VITRECTOMY WITH PLACEMENT OF AN OPEN-LOOP, FLEXIBLE ANTERIOR-CHAMBER LENS

Objective: There are many alternatives available to the vitreoretinal surgeon in the management of posteriorly dislocated intraocular lenses (IOL). The lens may be repositioned in the ciliary sulcus if there is adequate capsular support, but if this support is absent, it must eit her be sutured in place (to the sclera or iris) or exchanged for an an terior chamber (AC) IOL. Scleral-sutured IOLs can be associated with h emorrhage, cystoid macular edema, retinal detachment, and endophthalmi tis (through the suture tract), and use sutures that must last for the lifetime of the patient. Anterior chamber IOLs (ACIOLs) are easier to implant but require a limbal incision for insertion. The authors soug ht to determine the safety and efficacy of combining removal of poster iorly dislocated IOLs with ACIOL placement. Design: A retrospective ch art review, in which all cases of dislocated IOLs managed at the autho rs' institution over the last 5 years were reviewed. Patient character istics, pre-existing ocular conditions, preoperative visual acuity (VA ), intraocular pressure (IOP), type of lens dislocated, operation perf ormed, postoperative VA and IOP, and length of follow-up were recorded . Results: A total of nine cases were identified. Seven of these under went primary posterior chamber (PC) IOL removal with ACIOL implantatio n. One had an ACIOL placed after a sulcus-sutured PCIOL dislocated, an d one had enough capsular support for placement of a PCIOL after remov al of a plate haptic silicone lens. Of the seven primary ACIOL cases, the best-corrected VA improved in five cases, was unchanged in one (re mained 20/20), and declined in another. The final postoperative VA (me an follow-up, 12 months) was 20/30 or better in five patients, and was limited by age-related macular degeneration and epiretinal membrane i n the other two. A hyphema occurred in two patients and cleared in bot h without visual compromise. There was no evidence of corneal compromi se or exacerbation of glaucoma in any of the patients. Conclusions: Gi ven that the results and complication rates in this small series appea r to be similar to those reported for sulcus-suture techniques, implan tation of an ACIOL after removal of a posteriorly dislocated IOL appea rs to be a viable alternative to suture fixation in the absence of cap sular support.