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Surgical management of late in-the-bag IOL dislocation : a case series
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Introdução: A luxação espontânea tardia do complexo lente intra-ocular (LIO)-saco é uma complicação cada vez mais reportada da cirurgia das cataratas, com uma incidência reportada de 0,05 a 3%. Ocorre frequentemente devido à insuficiência zonular progressiva que pode surgir devido a factores tais como lesões induzidos às fibras zonulares durante a cirurgia das cataratas, e pode ser potenciada por outras condições, reportadamente pseudoexfoliação, aumento do comprimento axial ocular, cirurgia vítrea anterior, certas doenças do tecido conjuntivo e retinite pigmentar. Apesar da falta de consenso quanto à melhor solução cirúrgica, tanto o reposicionamento da LIO como a troca de LIO são opções viáveis, com resultados semelhantes. Diferenças em relação às complicações foram descritas. Diferentes técnicas cirúrgicas podem ser utilizadas, e novas técnicas cirúrgicas foram desenvolvidas nos últimos anos, incluindo o reposicionamento de LIO através de sutura escleral ou através de fixação sem sutura. Recentemente, surgiram também novos designs de LIO, como as lentes Carlevale.
Objetivos: Avaliar uma série de casos de luxação espontânea tardia do complexo LIO-saco em relação ao tipo de cirurgia, tipo de lente, complicações e resultados, e comparar os resultados obtidos com os resultados reportados na literatura revista.
Material e Métodos: Foi avaliada uma série de casos de luxação espontânea tardia do complexo LIO-saco submetidos a intervenção cirúrgica no Departamento de Oftalmologia do Hospital Universitário de Santa Maria, Portugal, entre 1 de Março de 2019 e 30 de Abril de 2021. O período de seguimento mínimo foi de 1 mês. Os parâmetros medidos incluem idade, género, tempo desde a cirurgia das cataratas até à luxação do complexo LIO-saco, tipo de cirurgia, tipo de lente, complicações cirúrgicas, melhor acuidade visual corrigida pré-operatória e pós-operatória (BCVA) e astigmatismo.
Results: LIO Carlevale de fixação escleral sem suturas e LIO iris-claw (Verisyse) retropupilar parecem ser opções de tratamento cirúrgico seguras para luxação espontânea tardia do complexo saco-LIO, com bons resultados visuais e com poucas complicações, maioritariamente ligeiras e transitórias.
Introduction: Late spontaneous in-the-bag dislocation of an intraocular lens (IOL) is an increasingly reported late complication of cataract surgery with a reported incidence of 0,05 to 3%. It often occurs due to progressive zonular insufficiency that may arise from factors such as damage induced to the zonula fibers during cataract surgery, and can be potenciated by other conditions, reportedly pseudoexfoliation (PEX), increased eye axial lenght, previous vitreoretinal surgery, certain connective tissue diseases and retinitis pigmentosa. Despite the lack of consensus regarding optimal surgical management, both IOL repositioning and IOL exchange are viable options, with similar outcomes. Differences regarding complications have been described. Different surgical techniques can be employed, and novel surgical techniques have been developed in recent years, including IOL repositioning via scleral suture or via sutureless fixation. Recently, new IOL designs have also been developed, such as Carlevale lens. Objetives: To evaluate a case series of spontaneous late in-the-bag IOL dislocations regarding type of surgery, type of lens, complications and outcomes, and to compare the obtained results with the results reported in the reviewed literature. Materials and Methods: A case series of spontaneous late in-the-bag IOL dislocation submitted to surgical intervention in the Department of Ophthalmology of the Santa Maria University Hospital, Portugal, between March 1, 2019 and April 30, 2021, were evaluated. The follow-up period was of 1 month. The parameters measured include age, gender, time from cataracts surgery until IOL dislocation, type of lens, type of surgery, surgical complications, preoperative and post-operative best corrected visual acuity (BCVA) and astigmatism. Results: Sutureless scleral-fixated Carlevale IOL and retro-pupillary iris-claw IOL appear to be safe surgical options for management of spontaneous late in-the-bad IOL dislocation, yielding good visual outcomes with few, mostly mild and transient complication.
Introduction: Late spontaneous in-the-bag dislocation of an intraocular lens (IOL) is an increasingly reported late complication of cataract surgery with a reported incidence of 0,05 to 3%. It often occurs due to progressive zonular insufficiency that may arise from factors such as damage induced to the zonula fibers during cataract surgery, and can be potenciated by other conditions, reportedly pseudoexfoliation (PEX), increased eye axial lenght, previous vitreoretinal surgery, certain connective tissue diseases and retinitis pigmentosa. Despite the lack of consensus regarding optimal surgical management, both IOL repositioning and IOL exchange are viable options, with similar outcomes. Differences regarding complications have been described. Different surgical techniques can be employed, and novel surgical techniques have been developed in recent years, including IOL repositioning via scleral suture or via sutureless fixation. Recently, new IOL designs have also been developed, such as Carlevale lens. Objetives: To evaluate a case series of spontaneous late in-the-bag IOL dislocations regarding type of surgery, type of lens, complications and outcomes, and to compare the obtained results with the results reported in the reviewed literature. Materials and Methods: A case series of spontaneous late in-the-bag IOL dislocation submitted to surgical intervention in the Department of Ophthalmology of the Santa Maria University Hospital, Portugal, between March 1, 2019 and April 30, 2021, were evaluated. The follow-up period was of 1 month. The parameters measured include age, gender, time from cataracts surgery until IOL dislocation, type of lens, type of surgery, surgical complications, preoperative and post-operative best corrected visual acuity (BCVA) and astigmatism. Results: Sutureless scleral-fixated Carlevale IOL and retro-pupillary iris-claw IOL appear to be safe surgical options for management of spontaneous late in-the-bad IOL dislocation, yielding good visual outcomes with few, mostly mild and transient complication.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2021
Palavras-chave
Pseudoexfoliação Alta miopia Luxação saco-LIO LIO Verisyse® Carlevale® Oftalmologia