Posterior optic capture for repositioning of dislocated three-piece intraocular lens: a single center retrospective study.

Abstract

Background: Intraocular lens (IOL) dislocations represent a serious complication of cataract surgery. In cases of isolated dislocation of a three-piece IOL, the dislocated IOL can be fixed in the ciliary sulcus. However, stability issues arise when the total haptic length does not match the ciliary sulcus distance or when zonular dehiscence causes the IOL to slip into the dehiscence site. Therefore, this study aimed to evaluate the efficacy of posterior optic capture (POC) for repositioning dislocated three-piece IOLs, with haptics fixated in the ciliary sulcus and the optic captured within a posterior capsular window.

Methods: The dislocated IOL was first refixed in the ciliary sulcus. A 25-gauge vitrectomy cutter was inserted through the corneal stab incision and positioned between the optic and posterior capsules to create a posterior capsular window with a 4-5 mm diameter. The optic was then pushed into the posterior capsular window and was captured. The surgical outcomes of 13 eyes from 13 patients who were followed for at least 12 months after surgery were retrospectively evaluated based on medical records.

Results: The mean time from IOL implantation to POC was 28.3 ± 23.8 months. The mean postoperative follow-up period was 19.9 ± 8.55 months. The mean surgical duration was 14.4 ± 6.8 min. No intraoperative complications were observed. The postoperative best-corrected visual acuity improved or remained unchanged in all patients. The mean change in spherical equivalent before and after surgery was 0.60 ± 0.65 D. The postoperative anterior chamber depth (ACD) was 4.29 ± 0.34 mm, which was increased from the preoperative ACD of 3.86 ± 0.48 mm (p < 0.05). The corneal endothelial cell density loss was 2.28 ± 3.96%. Postoperatively, one patient experienced recurrent IOL dislocation due to enlargement of the zonular dehiscence. In all other cases, slit-lamp examination and anterior segment optical coherence tomography (AS-OCT) confirmed stable IOL positioning and maintained optic capture. At the final visit, IOL decentration and tilt calculated from AS-OCT were 0.35 ± 0.22 mm and 2.68 ± 1.52°, respectively.

Conclusions: POC is a minimally invasive and straightforward technique for intermediate-term fixation of dislocated three-piece IOLs.