A comparison of visual results and complications in eyes with posterior chamber intraocular lens dislocation treated with pars plana vitrectomy and lens repositioning or lens exchange

Purpose: To compare the visual results and the postoperative complications in eyes with posterior chamber intraocular lens (PCIOL) dislocation that un derwent pars plana vitrectomy with lens repositioning with eyes that underw ent pars plana vitrectomy with lens exchange. Design: Nonrandomized consecutive comparative case series. Participants: Fifty-nine eyes (27 right eyes and 32 left eyes) of 56 subjec ts (28 women and 28 men) ranging in age from 59 to 90 years. Mean follow-up was 34 months. Methods: A comparison of the best-corrected preoperative visual acuities, f inal visual acuities, and postoperative complications in subjects with disl ocated PCIOLs that underwent pars plana vitrectomy. Logarithm of the minimu m angle of resolution (LogMAR)-converted visual acuities were used for comp arison. Categorical data were analyzed by Fisher's exact test, and populati on means were compared by a pooled Student's t test. Main Outcome Measures: Final mean visual acuities, change in mean visual ac uities, and postoperative complications. Results: For all 59 eyes the mean preoperative visual acuity was 20/152, an d the mean final visual acuity was 20/48. Final visual results were similar between the eyes that underwent lens repositioning (20/55) and the eyes th at underwent lens exchange (20/43; P = 0.19). Final visual results were als o similar between the eyes that underwent lens exchange with sutured PCIOL placement (20/51) and the eyes that underwent lens exchange with anterior c hamber intraocular lens (ACIOL) placement (20/38; P = 0.26). Final mean vis ual acuity in eyes that received an ACIOL (20/38) was better than in eyes t hat underwent repositioning of the dislocated lens into the ciliary sulcus (20/65; P = 0.01). The mean increase in visual acuities was greater for eye s with ACIOL placement compared with eyes with sutured PCIOL placement (P = 0.01). For all eyes, final visual results were unaffected by a concurrent diagnosis of age-related macular degeneration (20/52; P = 0.71), glaucoma ( 20/48; P = 0.95), or postoperative cystoid macular edema (20/55; P = 0.45), Final visual acuities were significantly worse in eyes with a detectable p reoperative afferent pupillary defect (20/200; P < 0.0001). Postoperative r etinal detachments developed in 4 of 29 eyes (14%) that underwent lens repo sitioning and in 2 of 30 eyes (7%) that had lens exchange (P = 0.42). Posto perative lens subluxations occurred in 6 of 29 eyes (21%) that underwent le ns repositioning and in 1 of 30 eyes (3%) that underwent lens exchange (P = 0.05). Conclusions: The final visual results in eyes with dislocated PCIOLs that u nderwent pars plana vitrectomy with lens repositioning were similar to the visual results obtained in eyes that underwent pars plana vitrectomy with l ens exchange. For eyes that underwent lens exchange, final visual results i n eyes that received an ACIOL were similar to the visual results obtained i n eyes that received a PCIOL; however, eyes with an ACIOL showed a greater increase in mean visual acuity. Eyes with a preoperative afferent pupillary defect had worse final visual results. Ophthalmology 2001;108:82-89 (C) 20 01 by the American Academy of Ophthalmology.