Posteriorly dislocated/subluxated cataractous lens: A surgical dilemma and management

Abstract

Aim To assess and compare the visual outcome of the different approaches in the management of dislocated/subluxated cataractous lens. Methods This is a retrospective study of 32 eyes of 32 patients who were managed for dislocation/subluxation of cataractous lenses from 2012 to 2015. All patients underwent 3PPPV/anterior vitrectomy with PFCL assisted extraction of the dislocated cataractous lens. 2 point ab-externo scleral fixated IOLs were implanted in 15 patients, ACIOL implantation was done in 2 patients and the remaining 15 patients who underwent Vitrectomy and lens removal were left aphakic due to various reasons (a)lost to follow up (b)fellow eye aphakic(c)had preoperative complications like Vitreous haemorrhage, Retinal break etc. The visual outcome of these various procedures were compared and analysed. Results Our study included 32 eyes of 32 patients with a median follow up period ranging from 3–36 months. SFIOLs were implanted in 15 patients, ACIOL implantation was done in 2 patients and 15 patients were left aphakic. Post-operative best corrected visual acuity of 6/18 or better was achieved in 73.33% of patients treated with SFIOL implantation. BCVA of 6/18 or better was achieved in 40% of patients who were left aphakic and given aphakic spectacle correction. The remaining 60% had a visual acuity of <6/36. Post-operative BCVA was ranging between 6/60-6/18 in patients with ACIOL implantation. Intraoperative complications were seen maximum in patients who were left aphakic, with 60% patients(9/15) having retinal breaks/RD. In the SFIOL group 6 eyes(40%) had early post-op complications as compared to 14 eyes (93.33%) in the aphakic group and 1 eye(50%) in the ACIOL group. Late post-op complications were noted similarly in both SFIOL and aphakic groups with 4 eyes(26.67%) affected in each group. One out of two patients(50%) in ACIOL group developed persistent uveitis as a late complication. Conclusion The post-operative visual outcome was good following both SFIOL and ACIOL implantation. However SFIOL implantation seems to have a lower post-op complication rate than ACIOL implantation. Patients who were left aphakic had numerous intra-operative and post-operative complications with dismal outcome. Hence, SFIOL implantation can be proposed as a novel approach towards the management of dislocated cataractous lenses.