In-bag dislocation of intraocular lens in patients with uveitis: a case series

BACKGROUND Improvement in surgical devices and intraocular lenses has made modern cataract surgery a safe procedure with decreasing complication rates. Intraocular lens dislocation is a serious complication after cataract surgery. Although most dislocations occur during the first week postoperative period, late intraocular lens dislocation occurring 3 months or later post-surgery has been reported with increasing frequency in recent years as a result of progressive zonular dehiscence. We report the clinical features, management and outcomes of five cases of late in-bag dislocation of intraocular lens in patients with underlying uveitis. This is a retrospective case series and literature review. RESULTS We identified five eyes in five patients with uveitis and late in-bag intraocular lens dislocation. Two patients had multifocal choroiditis, two herpetic uveitis and retinitis and two Fuchs' heterochromic iridocyclitis in five patients. Mean age at the time of cataract surgery was 50. Best vision ranged from counting fingers to 6/18 preoperatively and ranged from 6/36 to 6/6 postoperatively. All had right eye dislocation with mean time from initial cataract surgery to intraocular lens dislocation of 81 months. Explantation of dislocated intraocular lens and vitrectomy were performed in four cases; three had anterior chamber intraocular lens placement. One case was managed conservatively. Best vision ranged from light perception to 6/7.5 at time of dislocation and ranged from 6/36 to 6/6(-2) at follow-up. CONCLUSIONS Late in-bag dislocation intraocular lens can complicate cataract surgery in patients with underlying uveitis. This case series identified that the mean time to in-bag intraocular lens dislocation in five uveitis patients was 81 months after uncomplicated cataract surgery, comparable with the time reported in the available literature of patients with pseudoexfoliation syndrome. This series also found that lens explantation and replacement with anterior chamber intraocular lens achieved good outcomes. Further investigation is warranted to ascertain the strategies to identify patients at risk and to prevent and better manage intraocular lens dislocation in patients with uveitis.