Long-term results of late “in-the-bag” IOL dislocation surgery

BACKGROUND: Intraocular lens (IOL) repositioning and IOL exchange are the main methods of surgical treatment of late in-the-bag IOL dislocation. AIM: To evaluate refraction, induced corneal astigmatism and IOL tilt after surgical treatment of late in-the-bag IOL dislocation by transscleral suture fixation and exchange to iris-claw IOL with retropupillary fixation. MATERIALS AND METHODS: 78 of patients with late in-the-bag IOL dislocation were included. Transscleral suture IOL fixation was performed in group I (38 eyes), exchange to iris-claw IOL was performed in group II (40 eyes). Refractometry, keratotopography and optical coherence tomography of anterior segment were performed before surgery, 1 week, 1, 3 and 6 months after surgery. RESULTS: The groups did not differ in subjective and objective refraction. But there was significant variability of data in the group I 3 and 6 months after surgery. There was no difference in corneal astigmatism in both groups during 3 months, but a significant increase was found in group II 6 months after surgery. There was no difference in IOL tilt between groups before surgery. Decrease of IOL tilt in 180 degrees plane was observed after 1 month in group II, while there was no difference in 90 degrees plane between groups. CONCLUSIONS: Both methods of late in-the-bag IOL dislocation treatment allow to receive good refractive result, but refraction is less predictable after trans-scleral suture IOL fixation. Surgically induced astigmatism is higher in IOL exchange group due to large sclerocorneal tunnel incision. Transscleral suture IOL fixation does not cause clinically significant IOL tilt.