NEWS & OPINION EWAP MARCH 2022 65 to 0.46) (P=0.58). The mean change in spherical equivalent at final observation was –0.08 D (95% CI, –0.93 to 0.77) in the 1-piece group and –0.98 (–1.73 to –0.23) in the 3-piece IOL group (P=0.11). Discussion Existing literature raises safety concerns regarding a 1-piece IOL for repositioning in cases of late in-the-bag IOL dislocation, primarily due to potential for UGH syndrome. UGH syndrome can be caused by any IOL in the sulcus4 and even in the capsular bag with possible causes including a deformed haptic, out-of-the bag dislocation of the IOL or haptic, Soemmering’s ring, or pseudophacodonesis.8,9 This study suggests a similar safety profile between 1-piece IOL designs and 3-piece IOL designs with no instances of UGH syndrome. In the study, potential causes of UGH are addressed both preop by excluding any out-of-the bag dislocations and intraoperatively by using a surgical technique that secures the IOL with scleral sutures and thus should eliminate pseudophacodonesis. It is also noted that while CDVA was similar between the two IOL design groups, the postop change in spherical equivalent was –0.98 D for the 3-piece IOL group compared to –0.08 D for the 1-piece IOL group. This may be due to differences in the biomechanics of the IOLs as well as differences in haptic thickness and angle. This suggests that for repositioning of 3-piece IOLs, more posterior placement of the scleral sutures may be considered to avoid the associated relative myopic shift. Some limitations of this study include an analysis that is limited to comparing only the 1-piece and 3-piece foldable IOL designs, primarily because of insufficient power due to a low number of eyes with other IOL designs. While foldable 1-piece and 3-piece designs are the most common designs used during CEIOL, future studies comparing more IOL designs and materials would be beneficial. In addition, all cases were performed by a single surgeon using a singular technique. While this technique was found to be relatively safe in terms of outcomes, it would be beneficial to compare this technique with others, such as Yamane, as well as other scleral suturing techniques with and without scleral flaps. Another discussion point brought up during the ASCRS Journal Club was the use of 10-0 polypropylene sutures compared to 9-0 polypropylene or 8-0 Gore-Tex sutures. Given Repositioning surgery of different intraocular lens designs in eyes with late in-the-bag intraocular lens dislocation Marius Dalby, MD, Liv Drolsum, MD, Olav Kristianslund, MD J Cataract Refract Surg. 2021;47(9):1147–1152. Purpose: To evaluate the long-term efficacy and safety after intraocular lens (IOL) repositioning by scleral suturing of 1-piece IOL compared with other IOL designs in the treatment of late in-the-bag IOL dislocation. Setting: Patients referred to Oslo University Hospital. Design: Prospective cohort study. Methods: The study comprised 54 patients (54 eyes) with late inthe-bag IOL dislocation treated with IOL repositioning by scleral sutures (10-0 polypropylene). All operations were performed with an anterior approach and by one surgeon. The following IOL designs were repositioned: 1-piece foldable (n=17), 3-piece foldable (n=28), plate haptic (n=8), and 1-piece rigid (n=1). Patients were evaluated comprehensively before surgery, and 6 months (80%), 1 year (67%), and 2 years (È1%) after surgery. The main outcome measures were efficacy in terms of corrected distance visual acuity (CDVA) and spherical equivalent (SE), and safety in terms of complications. Results: Postoperative visual acuity was similar for different IOL designs. Mean SE change to final observation was –0.08 (9x% CI, –0.9Î, 0.ÇÇ) in the 1-piece group and –0.98 (–1.73, –0.23) in the 3-piece group (p=0.11). In terms of safety, no patients had uveitis-glaucoma-hyphema syndrome, retinal detachment, or endophthalmitis. The 3-piece group had 1 case of redislocation and 1 case of iritis. No patients had symptoms related to clinical IOL decentration. Long-term intraocular pressure remained within normal limits with overlapping 95% CIs for different IOLs. Conclusions\ ,epositioning surgery of 1-piece I"Ls appears as efficient and safe as that for other IOL designs in the treatment of late in-the-bag IOL dislocation. evidence of late dislocations of scleral-sutured PCIOL due to degradation of suture material over time, the use of larger diameter than 10-0 polypropylene suture material as well as placement of haptic and sutures in the ciliary sulcus may promote attachment of scar tissue and enhance long-term stability of scleral-fixated I"Ls.10 EWAP References 1. Monestam E. Frequency of intraocular lens dislocation and pseudophacodonesis, 20 years after cataract surgery—a prospective study. Am J Ophthalmol. 2019;198:215–222. 2. Kristianslund O, et al. Late in-thebag intraocular lens dislocation: a randomized clinical trial comparing lens repositioning and lens exchange. Ophthalmology. 2017;124:151–159. 3. Dabrowska-Kloda K, et al. Incidence and risk factors of late inthe-bag intraocular lens dislocation: evaluation of 140 eyes between 1992 and 2012. J Cataract Refract Surg. 2015;41:1376–1382.
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