If a cataract patient of your experiences intraocular lens (IOL) dislocation, you may be called upon to explain the options to a worried individual and perhaps recommend a fix to the surgeon. Turns out, repositioning and exchange are both equally efficient and safe as a long-term treatment for late in-the-bag IOL dislocation, a study in the American Journal of Ophthalmology reports.               

Researchers from Norway randomly assigned patients to either IOL repositioning by scleral suturing or IOL exchange by retropupillary fixation of an iris-claw IOL. A single surgeon performed all operations with an anterior approach, and patients were examined before surgery and six months, one year and two years after the procedure.

The final study included 66 patients (63% of the original 104 participants) who completed the two-year follow-up.

After two years, the mean corrected distance visual acuity was 0.20 ± 0.29 logMAR (range: -0.18 to 1.10) in the repositioning group and 0.22 ± 0.30 logMAR (range: -0.10 to 1.22) in the exchange group. The study also reported 76% of all patients achieved corrected distance visual acuity of 20/40 or better. Researchers found four eyes (12%) had cystoid macular edema in the repositioning group compared with five eyes (15%) in the exchange group. Additionally, two eyes had re-dislocation (one in each group), and the study found no cases of endophthalmitis or retinal detachment.

“There were no significant differences in visual acuity between IOL repositioning and IOL exchange two years after surgery,” the researchers wrote in their paper. “The two methods were equally efficient and safe from a long-term perspective and are both considered acceptable treatments.”

Dalby M, Kristianslund O, Drolsum L. Long-term outcomes after surgery of late in-the-bag intraocular lens dislocation: a randomized clinical trial. Am J Ophthalmol. June 10, 2019. [Epub ahead of print].