Abstract
Purpose To examine the intra- and postoperative factors leading to posterior chamber intraocular lens (IOL) decentration in patients requiring IOL exchange, and to identify avoidable causes of IOL decentration.
Methods Case records of 17 patients who had undergone posterior chamber IOL exchange were examined for: (i) any complication or alteration to the original intended surgical procedure, (ii) IOL type and position at the completion of initial surgery, (iii) IOL position at the time of re-operation.
Results The decentred lens implants were injected silicone plate-haptic IOLs in 10 patients, small (5.5 mm) optic diameter PMMA IOLs in 4 patients and large (7 mm) optic diameter PMMA IOLs in 3 patients. In all cases, decentration was due to IOL subluxation. Early decentration of the injected lenses was due to IOL implantation in eyes without a continuous capsulorrhexis. In contrast late decentration was due to subluxation associated with capsule fibrosis. Decentration of small optic PMMA IOLs was found to be associated with an anterior capsule tear and haptic malposition in the ciliary sulcus. Decentration of large optic PMMA IOLs was associated with posterior displacement of one haptic through a posterior capsule defect, zonule dehiscence or fixation of one haptic in the sulcus and one in the capsule bag.
Conclusion Clinically significant postoperative subluxation of injected silicone IOLs may be minimised by implanting only into a lens capsule bag with an intact capsulorrhexis. The risk of decentration of small optic PMMA IOLs may be minimised by positioning the haptics at 90° to any capsulorrhexis tear. After cataract surgery complicated by posterior capsule rupture or zonule dehiscence, it is important to assess the remaining capsule support and, where sufficient, implant a large optic diameter posterior chamber IOL in the ciliary sulcus.
Similar content being viewed by others
Article PDF
References
Sinskey RM, Amin P, Stoppel JO . Indications for and results of a large series of intraocular lens exchanges. J Cataract Refract Surg 1993;19:68–71.
CaIson AN, Stewart WC, Tso PC . Intraocular lens complication requiring removal or exchange. Surv Ophthalmol 1998;142:417–36.
Cumming JS . Surgical complications and visual acuity results in 536 cases of plate haptic silicone lens implantation. J Cataract Refract Surg 1993;19:275–7.
Walkow T, Anders N, Pham DT, et al. Causes of severe decentration and subluxation of intraocular lenses. Graefes Arch Clin Exp Ophthalmol 1998;236:9–12.
Ram J, Apple D, Visessook N, et al. Update on fixation of rigid and foldable posterior chamber intraocular lenses: 1. Ophthalmology 1999;106:883–90.
Kohnen T . Complications and complication management with foldable intraocular lenses. [editorial]. J Cataract Refract Surg 1998;24:1167–8.
Hayashi H, Hayashi K, Nakao F, et al. Area reduction in anterior capsule opening in eyes of diabetes mellitus patients. J Cataract Refract Surg 1998;24:1105–10.
Hayashi K, Hayashi H, Matsuo K . Anterior capsule contraction and lens dislocation after implant surgery in eyes with retinitis pigmentosa. Ophthalmology 1998;105:1239–43.
Davison J . Capsule contraction syndrome. J Cataract Refract Surg 1993;19:582–9.
Ulrich FC, Legler MD, Ehud I, et al. Prospective experimental study of factors related to posterior chamber intraocular lens decentration. J Cataract Surg 1992;18:449–55.
Assia RI, Legler UFC, Meril C, et al. A clinicopathologic study of the effect of radial tears and loop fixation on lens decentration. Ophthalmology 1993;100:153–8.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Tappin, M., Larkin, D. Factors leading to lens implant decentration and exchange. Eye 14, 773–776 (2000). https://doi.org/10.1038/eye.2000.202
Issue Date:
DOI: https://doi.org/10.1038/eye.2000.202
Keywords
This article is cited by
-
Intra-scleral fixation of the iris hooks for trans-scleral capsular bag fixation in patient with zonular dialysis
International Ophthalmology (2018)
-
A case of decentered IOL managed with optic buttonholing
International Ophthalmology (2014)
-
Decentration of a foldable single-piece acrylic IOL within the capsular bag
Eye (2006)