Management of subluxated and posteriorly dislocated intraocular lenses using pars plana vitrectomy instrumentation

Thirty-four patients with subluxated and posteriorly dislocated intraocular lenses (IOLs) had repositioning, replacement, or removal of the IOL using pars plana instrumentation. Of the 25 cases posteriorly dislocated into the formed vitreous, ten posterior chamber IOLs were repositioned into the ciliary sulcus, one anterior chamber IOL was repositioned into the anterior chamber angle, and eight posterior chamber IOLs were exchanged for anterior chamber IOLs through a limbal incision. In the remaining six cases, the IOL was removed but was not replaced because of concurrent ocular pathology. In nine cases with subluxation of an anterior chamber IOL into a large basal iridectomy, a pars plana approach after vitrectomy was used for repositioning the IOL into the anterior chamber angle. Complications included each of the following: intraoperative retinal dialysis, postoperative extension of a pre-existing subclinical retinal detachment, recurrent subluxation of an anterior chamber IOL, breakdown of chronic cystoid macular edema to form a macular hole, and pseudophakic pupillary block requiring laser iridotomy.     

Management of posteriorly dislocated intraocular lens using pars plana vitrectomy

In order to evaluate the results of pars plana vitrectomy (PPV) for the treatment of posteriorly dislocated intraocular lens (PC-IOL), we retrospectively examined and analyzed the hospital records of patients who had undergone PPV to exchange or reposition a PC-IOL dislocated into the vitreous cavity. Of 20 eyes in 20 patients, IOL exchange was performed in 6 eyes, and IOL repositioning in 14 eyes. Posteriorly dislocated IOL occurred in 14 eyes during or within 2 days, and in 6 eyes 6 months after the IOL implantation. Thirteen eyes were surgically treated early after the occurrence, within 3 days, while 7 eyes were treated later, between 5 to 7 days. Compared with preoperative best-corrected visual acuity, the final visual acuity improved more than 2 lines in 12 eyes. With no significant difference on the statistics, earlier visual rehabilitation seemed to be shown in late-treated patients than in early-treated. Accordingly, a posterior dislocation of IOL can be successfully treated with PPV, and barring any serious complications such as retinal detachment, there is no need for surgery immediately following the occurrence.     

改良四通路玻璃体切割在人工晶状体后脱位治疗中的应用

目的:报道改良四通路玻璃体切割术治疗1例后房型人工晶状体后脱位.方法:一位青年性白内障患者,双眼白内障术后均发生人工晶状体后脱位,其1眼应用改良四通路玻璃体切割技术将人工晶状体复位,另1眼应患者的要求而未行手术治疗.结果:术中和术后未发生任何并发症,患者术眼视力迅速回复,术后14 mo最佳矫正视力为0.5;而未行手术治疗的另1眼发生全视网膜脱离,仅残余手动视力.结论:改良四通路玻璃体切割术是治疗人工晶状体后脱位的一个好选择.     

Intravitreal phacoemulsification with pars plana vitrectomy and posterior chamber intraocular lens suture fixation for dislocated crystalline lenses.

This technique to manage a dislocated crystalline lens comprises intravitreal phacoemulsification with transscleral suture fixation of a posterior chamber intraocular lens (IOL). The dislocated lens in the vitreous cavity is removed using a standard phaco handpiece with the assistance of a fiber-optic light pipe. Then, the IOL is implanted. The technique was used in 10 eyes of 8 patients with lens luxation or subluxation. The postoperative best corrected visual acuity was 20/25 or better except in 1 eye, and no serious complications were observed. Increased intraocular pressure before surgery in 4 eyes was normalized in 3 eyes.     

Pars plana vitrectomy in the management of subluxed and posteriorly dislocated intraocular lenses

The results of pars plana vitreous microsurgery in a series of nine patients with subluxed or posteriorly dislocated intraocular lenses (IOL) are described. Two posterior chamber intraocular lenses were repositioned in the ciliary sulcus anterior to the zonular ring. One posteriorly dislocated anterior chamber IOL was retrieved from the vitreous gel and repositioned into the anterior chamber angle. In three cases, stable repositioning of the dislocated posterior chamber IOL could not be achieved and the lens was exchanged by way of a limbal incision for an appropriate anterior chamber IOL. In three cases, and anterior chamber IOL subluxed into a large basal iridectomy was successfully repositioned using similar instrumentation.Presented at the XVth Meeting of the Club Jules Gonin, Copenhagen, 10–15 August 1986     

Visual outcome and complications of pars plana vitrectomy for dislocated intraocular lenses

Objective

To report factors predicting the visual outcome and complications in eyes that underwent pars plana vitrectomy (PPV) to manage dislocated intraocular lenses (IOLs).

Patients and methods

A retrospective chart review was performed. Clinical data recorded from the patient charts include, demographic, preoperative, intraoperative, and postoperative, with emphasis on visual acuity, interval between IOL dislocation and pars plana vitrectomy, surgical method and complications. Patients with follow-up of less than three months were excluded.

Results

Ninety-four patients were identified, 63 males and 31 females. Age ranged from 2 to 85 years (mean 52.6). The range of follow-up was 3 to 108 months (mean ± SD 19.4 ± 17.4 months). The final visual acuity was 20/50 or better in 52 (55.3%) eyes. Our analysis indicated that visual rehabilitation with IOL was significantly associated with better visual acuity as compared with eyes that were left aphakic (P = 0.0092). There was a trend toward a better visual outcome when PPV was performed within two weeks from the diagnosis of the dislocated IOL which was associated with good visual outcome (20/200 or better) in 85.7% of eyes compared with 78.8% of eyes. Management of IOL by interofixation was associated in (90.0%) of eyes with good vision (20/200 or better) compared to 76.1% eyes that had exchange of IOL through the limbus. Postoperative complications include cystoid macular edema in 9 (9.6%), glaucoma in 9 (9.6%), bullous keratopathy in 8 (8.5%), retinal detachments in 6 (6.4%) eyes, and relapsing uveitis in 2 (2%).

Conclusion

In this series, the final visual outcomes were improved and the rate of postoperative complications were low. Eyes that were pseudophakic had significantly good visual outcome compared with eyes that were left aphakic. To the best of our knowledge, this may be the largest study on dislocated IOL removal by PPV with good visual results compared to other studies.     

Management of dislocated posterior chamber intraocular lenses

Management options for posteriorly dislocated posterior chamber intraocular lenses include observation, removal, exchange, and repositioning. Many microsurgical techniques have been developed for repositioning posterior chamber implants. These include repositioning into the ciliary sulcus without suturing if adequate posterior capsule support remains, iris fixation suturing techniques, and scleral fixation suturing techniques. The indications, timing, and techniques for intervention are reviewed in a series of 32 cases with posteriorly dislocated posterior chamber implants. A final visual acuity of 20/40 or better was achieved in 15 (79%) of 19 IOL repositioned cases, in 6 (75%) of 8 IOL exchanged cases, and in 1 (33%) of 3 IOL removed cases. In two patients observed without surgery, final visual acuity was 20/25 and 20/300, respectively.     

Pars plana vitrectomy in the management of dislocated posterior chamber lenses

We used pars plana vitrectomy techniques in the management of pseudophakia and a dislocated posterior chamber lens in 17 patients. In six patients, the implant was decentered with the optic axis still located in the visual axis. In nine patients, the implant was rotated inferiorly and posteriorly but with the haptic still adherent to the vitreous base. In two patients, the implant was dislocated into the vitreous cavity. Surgical repositioning of the implant was indicated in 12 (71%) patients because of retained lens material, vitritis, vitreous adhesion to the cataract wound, vitreous hemorrhage, or retinal detachment. Preoperatively, visual acuity ranged from 20/30 to hand motions. Postoperatively, visual acuity ranged from 20/20 to 20/400. In eight patients, visual acuity was improved to 20/25 or better.     

Pars plana vitrectomy with posterior iris claw implantation for posteriorly dislocated nucleus and intraocular lens

We evaluated the safety and efficacy of pars plana vitrectomy (PPV) with primary posterior iris claw intraocular lens (IOL) implantation in cases of posterior dislocation of nucleus and IOL without capsular support. This was a retrospective interventional case series. Fifteen eyes underwent PPV with primary posterior iris claw IOL implantation performed by a single vitreoretinal surgeon. The main outcome measures were changes in best corrected visual acuity and anterior and posterior segment complications. A total of 15 eyes were included in this study. Eight had nucleus drop, three had IOL drop during cataract surgery and four had traumatic posterior dislocation of lens. The final postoperative best corrected visual acuity was 20/60 or better in 11 patients. This procedure is a viable option in achieving good functional visual acuity in eyes without capsular support.     

状体超声乳化玻璃体切割及后房型人工晶状体植入术

目的　评价晶状体超声乳化玻璃体切割及后房型人工晶状体植入术的临床疗效。方法　对16例患者行晶状体超声乳化玻璃体切割及后房型人工晶状体植入术。结果　3～10个月随访中,所有患者术后视力都有不同程度提高,视力05以上者6例(375%),02～04者7例(4375%),01以下者3例(1875%)。结论　玻璃体切割术中行晶状体超声乳化术联合后房型人工晶状体植入术,能够获得良好视力而无严重并发症,是治疗白内障合并眼后段病变一种较理想的手术。     

晶状体超声乳化玻璃体切割及后房型人工晶状体植入术

目的 评价晶状体超声乳化玻璃体切割及后与人工晶状植入术的临床疗效。方法 对１６例患者行晶状体超声乳化玻璃体切割及后房型人工晶状体植入术。结果 ３－１０个月随记中,所有患者术后视力都有不同程度提高,视力０．５以上者６例（３７．５％）,０．２－０．４者７便（４３．７５％）,０．１以下者３例（１８．７５％）。结论 玻璃体切割术中行晶状体超声乳化术联合后房型人工晶状体植入术,能够获得良好视力而无严重并发症     

白内障超声乳化,玻璃体切除及人工晶体植入联合手术的疗效

目的：探讨白内障超乳化摘除,睫状体平坦部下班体切割及人工晶体囊袋内植入联合手术的疗效及安全性。方法：对玻璃体视网膜病普合并白内障１８例（１８眼）施行该联合手术。其中糖尿病性视网膜病变,玻璃体出血伴白内障１０例;视网膜分枝静脉阻塞,玻璃体出血伴白内障４例;视网膜静脉周围炎,玻璃体出血伴白内障３例及特发性视网膜１例,术后随访２～１３个月（平均９月）。结果：术后视力均有不同程度提高。１２眼（６７％）术后     

眼后段异物摘出术中玻璃体切除的应用

目的 评价玻璃体切除术治疗眼后段异物的效果。方法 对32例（34眼）的住院患者进行回顾性研究。结果 本组患者均一次摘出异物，异物摘出率达100％；视力稳定或提高者29眼（85．3％），视力下降者5眼（14．7％）。结论 玻璃体切除术有利于摘出异物，并可治疗异物存留的并发症，提高术后视力。     

玻璃体切除联合后房人工晶状体缝线固定术治疗晶状体脱位

目的探讨玻璃体切除联合后房型人工晶状体缝线固定术治疗晶状体脱位的临床效果。方法各种原因所致的晶状体脱位30例（全脱位11眼,不全脱位22眼,共33眼）,进行玻璃体切除及晶状体切除或晶状体摘出。其中7眼采用三通道睫状体平坦部入口,26眼采用角膜缘入口。30例（33眼）均同时行Ⅰ期睫状沟缝线固定后房人工晶状体植入术。术后随访时间2~24个月,平均9个月,观察术后视力及并发症等。结果术后视力提高31眼,视力不变2眼,术后均未发现严重并发症。结论玻璃体切除联合后房型人工晶状体缝线固定术是治疗晶状体脱位最为安全和有效的治疗方法。熟练的手术技巧和术中稳定的眼内压是手术成功的保证。     

Posterior chamber intraocular lens implantation during diabetic pars plana vitrectomy

Combined cataract removal, posterior chamber intraocular lens (PC IOL) implantation, and pars plana vitrectomy were performed in 15 diabetic patients who presented with coexisting cataract and vitreoretinal complications from proliferative diabetic retinopathy (PDR). Posterior chamber IOLs were placed anterior to the anterior lens capsule after pars plana lensectomy and vitrectomy in nine eyes, whereas extracapsular cataract extraction (ECCE) with PC IOL placement was performed before vitrectomy in six eyes. Panretinal laser endophotocoagulation was applied in 13 of the 15 eyes as an important part of the operative procedure. Because of inactive diabetic retinopathy or satisfactory preoperative panretinal photocoagulation, 2 of the 15 eyes did not receive laser endophotocoagulation. Visual acuity was improved in 12 eyes and was similar to preoperative vision in 3 eyes. After a minimum of 6 months and a maximum of 28 months of follow-up, the visual results are the following: 20/40 or better (4 eyes), 20/50 to 20/200 (5 eyes), 20/400 to 5/200 (5 eyes), and hand motions (1 eye). Although 5 of the 15 eyes required secondary vitreoretinal procedures, neovascular glaucoma and complications attributable to the IOL did not occur. A recurrent postoperative retinal detachment (RD) developed with subsequent hypotony and rubeosis iridis in 1 of the 15 eyes.     

Determinants of visual outcome after pars plana vitrectomy for posteriorly dislocated lens fragments in phacoemulsification

PURPOSE: To evaluate the visual outcome of patients with posteriorly dislocated lens fragments after phacoemulsification managed with pars plana vitrectomy (PPV) and identify risk factors for poor visual outcome. SETTING: Vitreo-Retinal Service, St. Paul Eye Unit, Liverpool, United Kingdom. METHODS: The medical records of all patients who had PPV for posteriorly dislocated lens fragments after phacoemulsification between March 1993 and August 1998 were retrospectively reviewed. Demographics, preexisting eye conditions, details of the previous cataract surgery, findings at presentation, details of the vitreoretinal procedure, final visual acuity, and complications observed during the follow-up were evaluated. Univariate and multiple regression analyses were used to determine the significance of these clinical variables as determinants of poor visual outcome (visual acuity 6/12 or worse). RESULTS: Of the 106 patients identified, 89 had a full set of data and were included in the study. In 79 patients (89%), PPV was performed from 1 to 357 days (median 15 days) after cataract extraction. In 10 patients (11%), PPV was done on the same day as the cataract surgery. Sixty-two patients (69%) had a final visual acuity of 6/12 or better. Preexisting eye disease (P <.01), PPV delayed for more than 4 weeks (P <.03), occurrence of retinal detachment after vitrectomy (P <.01), and the use of ultrasound (US) fragmentation (P <.01) were statistically significantly correlated with a poor visual outcome. CONCLUSIONS: Posterior dislocated lens fragments after phacoemulsification were safely retrieved using PPV. It appears that intervening early (within 4 weeks) and avoiding the use of US fragmentation are associated with a better visual outcome and reduced rate of postoperative complications.     

Management of surgically dislocated intravitreal lens fragments by pars plana vitrectomy.

We examined 26 eyes (19 of them following phacoemulsification) with surgically dislocated intravitreal lens fragments; 24 eyes were subsequently operated on using pars plana vitrectomy for removal of lens fragments. From this select group of patients we found moderate to severe uveitis, glaucoma, and vitreous opacification present in virtually all cases. Less common complications were retinal detachments (six cases) and bullous keratopathy; the latter problem was found most commonly in eyes subjected to anterior segment maneuvers such as the use of lens loops or vitreous irrigation for removal of the lens material. Pars plana vitrectomy proved an excellent method for removal of lens fragments. A simultaneous two-instrument technique using the Wilson foreign-body forceps and the vitrectomy machine facilitated removal of the denser sclerotic lens fragments. This procedure resulted in resolution of the uveitis and glaucoma with improvement in visual acuity in 20 of the 24 eyes. However, only 10 of the 24 patients operated on obtained 20/40 or better visual acuity. A relatively prompt pars plana vitrectomy in eyes subjected to a minimum of surgical trauma yielded the best visual results.