8 EyeWorld Asia-Pacific | March 2025 FEATURE Ridley Lecture 2024, presented at the 42nd Congress of the ESCRS in Barcelona by Abhay Vasavada, MD Late Decentration Of IOLs – An Enigma How often do we face this question from a healthy patient with healthy eyes undergoing cataract surgery: “Doctor, will I need to change the IOL in future? Is it going to last all my life?’’ Late decentration of IOL following an uneventful inthe-bag IOL implantation occurring several years later manifests in two ways. One: where decentration of the entire capsular bag containing the IOL occurs. Although we describe this as an IOL decentration, it is the bag which decenters and it is primarily a zonular disease (Figure 1 & 2). Risk factors for this zonulopathy are well studied, pseudoexfoliation being a number one cause. The other way the late decentration occurs several years following uneventful cataract surgery is as a result of spontaneous rupturing of the posterior capsule (Figure 3), primarily a capsular disease. Globally speaking, quite a few surgeons have been reporting this condition in recent times, and across various platforms. This entity was recently coined by Dr. Samuel Masket as the Dead Bag Syndrome1. In the Dead Bag Syndrome, the capsule remains very clear without fibrotic changes and very thin (Diaphanous). Typically, posterior capsule rupture occurs but the capsule bag remains in-situ with total or partial zonular support1 (Figure 4). Figure 1: (Left) Capsular Phimosis and Fibrosis with a decentered bag, with IOL inside the bag. (Right) Total dislocation of the bag along with IOL and Capsule Tension Ring (CTR) on the retina. Source: Abhay Vasavada, MD Figure 2: Schematic illustration of Zonulopathy; Left panel shows the intact zonules and right panel shows zonular breaks. Source: Abhay Vasavada, MD
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