CATARACT 22 EWAP SEPTEMBER 2022 Contact information Mamalis: nick.mamalis@hsc.utah.edu Safran: safran12@comcast.net L ens dislocation is a spectrum. It can be anywhere from a small amount of decentration to a complete dislocation with the IOL-capsular bag complex sinking into the posterior chamber or falling into the vitreous. It can occur in the immediate postoperative period or “late,” which is considered anything after 3 months postop, according to Nick Mamalis, MD. For the most part, Dr. Mamalis said, spontaneous late IOL dislocation occurs about 10 years postop. In this article, EyeWorld looks at late dislocations that don’t appear to be related to surgical complications. Late dislocations have different etiologies. Trauma can dislocate the lens-bag complex, but the physicians EyeWorld spoke to, Dr. Mamalis and Steven Safran, MD, focused on spontaneous late dislocations. Why lens-bag complexes dislocate The most common reason Dr. Mamalis and Dr. Safran cited for spontaneous lens-bag dislocations is pseudoexfoliation syndrome. Dr. Mamalis said the Ophthalmic Pathology Laboratory at the John A. Moran Eye Center has conducted Spontaneous lens dislocation: Why it occurs, when, management, and other insights by Liz Hillman EyeWorld Editorial Co-Director studies on dislocated IOLs and capsular bags that have been sent to it over the years, finding that pseudoeÝfoliation (or exfoliation syndrome) is the most common factor that seems to be associated with late IOL dislocations. “We’re finding that eÝfoliation syndrome might be related to up to two-thirds of these,” he said. Dr. Mamalis said that during surgery the signs of pseudoexfoliation can be subtle and easy to miss. He said that exfoliation syndrome seems to pose a “triple threat” to the zonules. Material from exfoliation deposits where the zonules attach to the capsular bag, where the zonules insert to the ciliary body, and on the zonules themselves. “All of this adds up to diffuse weak zonules that can lead to spontaneous dislocation,” Dr. Mamalis said. Dr. Mamalis and Dr. Safran also said prior vitreoretinal surgery seems to be associated with late lens-bag dislocations. “There’s something about the vitrectomy procedure where the gelatinous vitreous is replaced by yuid, and that can cause the zonules to stretch and put more stress on them,” Dr. Mamalis said, adding that about 20% of late dislocations have had vitrectomy. Dr. Safran said that a lot of fibrosis of the capsular bag seems to be related to late dislocation as well. The fibrosis leads to matrix metalloproteinase production, which can dissolve the zonules over time. On the yip side, some cases of dislocation have a complete lack of fibrosisÆ the capsules are completely clear and diaphanous. This condition This article originally appeared in the June 2022 issue of EyeWorld. It has been slightly modified and appears here with permission from the ASCRS Ophthalmic Services Corp. An example of dead bag syndrome. Source: Steven Safran, MD
RkJQdWJsaXNoZXIy Njk2NTg0