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• W2014807260 abstract "In the past 3 decades, research in intraocular lens (IOL) pathology has shown that the optimal position for posterior chamber IOLs is the capsular bag. Since the first IOL was implanted by Harold Ridley in 1949, development has been focused on finding an IOL to correct aphakia that is stable and safe in the eye. With advanced IOL designs and capsular bag positioning, early refractive rehabilitation and long-term stability with little posterior capsule opacification can be achieved. However, any disease that causes a progression in zonular weakening or capsule contraction can lead to late IOL dislocation, which may have an effect on quality of vision. In this issue, the overview article by Gimbel et al. (pages 2193–2204) describes the most common conditions that predispose to late IOL dislocation. These include pseudoexfoliation, uveitis, trauma, vitrectomy, and increasing axial length. In these conditions, zonular weakness allows the IOL to move within the capsular bag or the entire capsular bag to dislocate. Worldwide, the IOL is a success story. Those who perform cataract surgery today find it hard to image a time when aphakia could not be corrected at the time of cataract removal. With modern monofocal IOLs, we have achieved a high standard of visual recovery, IOL safety, and patient satisfaction. However, the ongoing effort to improve visual quality after crystalline lens removal means that long-term stability of the pseudophakos will become increasingly important. Aspheric, toric, and multifocal IOLs, as well as IOLs that affect the restoration of accommodation, can be affected by decentration. But it is not only the IOL; it is also the precondition that makes long-term stability of the IOL in the capsular bag important. If the concept of weakened zonules, eg, in highly myopic eyes, is understood, careful treatment of the capsular bag during and following cataract or refractive lens extraction should be mandatory. Gimbel et al. caution surgeons to implant a posterior chamber IOL in the capsular bag in eyes with compromised zonules if progressive damage is anticipated. If these eyes are not monitored, complete luxation of the capsular bag–IOL complex may occur, which would eventually necessitate surgery. In extracapsular cataract extraction, special care should be given to capsulorhexis size, intraoperative manipulation of the entire capsular bag, and choice of an IOL. Additional devices such as the capsular tension ring may be used to prevent late IOL complications, but there are no long-term results with these implants. Gimbel et al. provide a variety of management options, and it is worthwhile studying the methods of refixating and exchanging dislocated IOLs that they describe. Surgical options to improve late complications are available and usually result in good visual outcomes; however, with advanced IOL technology, further efforts to guarantee the long-term position of the new IOL optics are necessary." @default.
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• W2014807260 date "2005-11-01" @default.
• W2014807260 modified "2023-10-13" @default.
• W2014807260 title "Late intraocular lens dislocation" @default.
• W2014807260 doi "https://doi.org/10.1016/j.jcrs.2005.10.020" @default.
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