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Spontaneous Dislocation of Intraocular Lens as a Late Complication of Cataract Surgery in Pseudoexfoliation Patients - Three Cases

Höhn S., Spraul C. W., Buchwald H.-J., Wagner P., Lang G. K.,
Universität Ulm, Augenklinik und Poliklinik (Ulm)

Purpose: Pseudoexfoliation syndrome (PEX) is associated with zonular weakness and a higher frequency of intraoperative complications during cataract surgery including rupture of the posterior lens capsule, zonular dialysis and postoperatively occuring rise of intraocular pressure. Delayed dislocation of an IOL is a rarely reported phenomenon.
Patients: Within six months late dislocation of the lens capsule with the in the bag fixated IOL was observed in three patients (74, 79 and 92 years old) with pseudoexfoliation syndrome following cataract surgery.
Results: All patients had an uneventful in the bag implantation of the IOL 6 respectively 10 years ago. Postoperatively occuring secondary cataract was treated by a YAG-capsulotomy in two cases (one month respectively three years prior to subluxation of the IOL). No patient had any other predisposing factors that would lead to zonular weakness beside pseudoexfoliation syndrome. The dislocation of the IOL occured spontaneously. In one patient with preexisting glaucoma the dislocation was followed by an increase of intraocular pressure. All cases were successfully treated with IOL explantation, anterior vitrectomy and placement of an anterior chamber IOL. Two patients achieved final best corrected visual acuity of 20/30, one with preexisting age-related macula degeneration 20/80.
Conclusions: Patients with pseudoexfoliation syndrome who undergo cataract surgery may be at risk not only for intraoperative complications but also for delayed spontaneous dislocation of the IOL. This possible complication should be considered in surgical planning for patients with pseudoexfoliation syndrome. In these patients it may be better to implant the IOL in the ciliary sulcus.