Late dislocation of scleral-sutured posterior chamber intraocular lenses
Accepted 23 December 2004.
Purpose
To examine a recent series of late scleral-sutured posterior chamber intraocular lens (PCIOL) dislocations to identify possible causes and preventive measures.
Setting
Price Vision Group, Indianapolis, Indiana, USA.
Methods
In this retrospective non-comparative interventional case series, 5 consecutive patients received treatment for dislocated scleral-sutured PCIOLs between July 2002 and March 2004. Dislocated lenses were resutured or replaced with another scleral-sutured PCIOL.
Results
Dislocation of scleral-sutured PCIOLs occurred 7 to 14 years after implantation. Four dislocations were spontaneous, and 1 was precipitated by trauma. In each case, the suture affixing 1 or both haptics failed. There was no evidence that the suture had eroded through the tissue or that the knot had untied. Microscopic analysis of an explanted IOL with remnants of the suture attached showed localized degradation and cracking of the polypropylene suture material where it had been embedded in the scleral tissue.
Conclusion
Suture-fixated PCIOLs can dislocate due to degradation of the suture material over time. The use of larger diameter (9-0 instead of 10-0) polypropylene suture material and placement of the haptic and sutures in the ciliary sulcus to promote attachment of scar tissue may enhance the long-term stability of scleral-fixated PCIOLs.
From the Cornea Research Foundation of America (M. Price), and the Price Vision Group (F. Price), Indianapolis, Indiana; the John A. Moran Eye Center (Werner, Mamalis), University of utah, Salt Lake City, Utah; and Luther Midefort's Eye Care Center (Berlie), Eau Claire, Wisconsin, USA
Reprint requests to Francis W. Price, Jr., MD, Price Vision Group, 9002 North Meridian Street, Suite 100, Indianapolis, Indiana 46260, USA.
Supported in part by the Research to Prevent Blindness Olga Keith Wiess Scholar Award to Liliana Werner, MD, PhD.
No author has a financial or proprietary interest in any material or method mentioned.
ABSTRACT