Spontaneous late dislocation of intraocular lens within the capsular bag in pseudoexfoliation patients

Purpose: To identify a delayed complication of cataract surgery in patients with zonular weakness caused by pseudoexfoliation syndrome. Design: Retrospective observational case series. Participants: Eight eyes in seven patients with clinically diagnosed pseudo exfoliation syndrome who had undergone previous uncomplicated cataract extr action and placement of a posterior chamber intraocular lens. Methods: This study evaluated eight cases of late spontaneous dislocation o f posterior chamber intraocular lenses within the capsular bag in patients with pseudoexfoliation syndrome. Data were gathered retrospectively from pa tients' operative reports, medical records, and pathology reports. Main Outcome Measures: (1) Interval between original surgery and dislocatio n; (2) final best-corrected visual acuity and ocular outcome. Results: All patients had a diagnosis of pseudoexfoliation syndrome and had previously undergone uncomplicated cataract surgery. No patient had any ot her predisposing factors that would lead to zonular dehiscence or weakness. Delayed dislocation of the entire capsular bag containing the intraocular lens (IOL) occurred spontaneously in all cases. Mean time from IOL implanta tion to dislocation was approximately 85 months (7 years and 1 month; range , 57-115 months) after surgery. Seven eyes were treated successfully with I OL exchange: six with placement of an anterior chamber IOL and one with scl eral fixation of a posterior chamber IOL. The remaining case was treated by scleral fixation of the dislocated IOL. Gross pathology analysis of seven cases confirmed the presence of the IOL within the intact capsular bag. Six eyes have achieved final best-corrected visual acuity of 20/40 or better. Conclusion: Patients with pseudoexfoliation syndrome may be at risk for del ayed spontaneous dislocation of IOL within the capsular bag after uncomplic ated cataract surgery. Awareness of this newly recognized long-term complic ation may justify a reevaluation of surgical considerations for cataract re moval in these patients. Ophthalmology 2001;108:1727-1731 (C) 2001 by the A merican Academy of Ophthalmology.