an epidemic of dislocated iols?

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An Epidemic of Dislocated IOLs?. Garth Stevens Jr. MD Eye Care Center of Virginia Mary Washington Eye Care Center. Financial Disclosure. The speaker is a paid consultant to Allergan, Inspire, and Abbott Medical Optics. Observation. Increased incidence of IOL dislocation the last 5 years. - PowerPoint PPT Presentation

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  • An Epidemic of Dislocated IOLs?

    Garth Stevens Jr. MD

    Eye Care Center of VirginiaMary Washington Eye Care Center

  • Financial DisclosureThe speaker is a paid consultant to Allergan, Inspire, and Abbott Medical Optics

  • ObservationIncreased incidence of IOL dislocation the last 5 years

  • Incidence over timeRetina Institute of Virginia (379.39,996.53)2006: 122007: 172008: 232009: 222010: 23Eye Care Center of Virginia2000 to 2006: 142007: 122008: 152009: 182010: 15

  • Question: is there an increased incidence of dislocated IOLs over the last decade? Davis et al Ophthalmology 2009, 116, 664-670.86 cases in bag pathology specimens2000-2006: 272006-2008: 59Associated diagnosisPseudoexfoliation (PXF) 50%Vitreo-retinal surgery19%Trauma16%Unknown 23%Uveitis2%

  • Incidence of IOL dislocationUnclear, older reports from 1980s 0.2 to 3%, no good recent data. Certainly less than 1% with modern cataract surgery techniquesClark .2% 10 y period others 0.6% over 10 y, with 2% with phakodonesisHow many of you have experienced in the bag dislocations, out of bag dislocations??

  • Role of capsular phimosisMechanismsPreop zonules weak, surgery, capsular contraction, post op traumaExerts traction on zonules and may be related to dislocationsShould we avoid small capsulorhexis in high risk patients?

  • Capsular phimosis as a cause of dislocation

  • Open questionsDo capsular tension rings decrease the incidence of late dislocation of IOLs in PXF? Probably yes with the Cionni ring and scleral fixationShould we ensure that capsulotomy openings are larger in PXF to avoid capsular contraction syndrome?

  • Cofactors in DislocationsEARLYCapsular ruptureCapsular instabilityLATEPseudo-exfoliationVitreoretinal surgeryTraumaUveitisCataract surgery complicationsYag capsulotomyCapsular contraction syndrome

  • Dislocated with attached capsuleCourtesy J. Astruc

  • Iris sutured IOL10-0 prolene

  • Primary treatment concernsWhen to intervenePseudo-phakodonesisSubluxationDislocationFactorsAge

  • Surgical decisionsReplace or repositionReplace Damaged hapticOpacified opticOne piece PMMA IOL with suturing eyelets in hapticsScleral fixation with prolene or Gore-Tex sutures

    AlternativeAC IOLIn bag suturing to sclera or irisFibrin glue to haptics under sclera

  • Steps in reposition with McCannell suture to the iris: All lens typesPosition in ACVitrectomy, retina back-upRemove capsule and retained lens materialDecide on replace or repositionHaptic behind iris with safety sutureSuture 10-0 prolene, CTC 6 needle, into iris, beneath haptic, out iris and tie looselySuture second hapticCheck positionTighten suturesiridoplasty

  • 90 y o, 20 y after cataract surgery, 3 y after suturing of left eye, 20/400 preop, 20/40 post op, removal retained lens material

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