Adverse Events Associated With Posteriorly Dislocated Intraocular Lenses in the Vitreous Cavity Without Surgical Intervention

Abstract

Purpose: To analyze the risk of complications attributed to posteriorly dislocated intraocular lenses in the vitreous cavity. Methods: Retrospective cohort study of posteriorly dislocated intraocular lenses from January 2016 to April 2022. Charts were analyzed to determine complication rates and characteristics in eyes with posteriorly dislocated intraocular lenses located in the vitreous cavity (prior to or without ever undergoing repair). Results: A total of 345 eyes met inclusion criteria. The intraocular lens was dislocated for ≥90 days in 72 eyes, ≥180 days in 52 eyes, and ≥1 year in 42 eyes (mean follow-up duration, 244.8 days); 316 of 345 eyes (90.7%) had no complications. Most complications (90.6%) occurred within ≤60 days of dislocation. The total, major, and minor complication rates at any time point were 9.3%, 4.9%, and 4.4%, respectively. Seventeen major complications (7 rhegmatogenous retinal detachment, 5 retinal break, 4 vitreous hemorrhage, 1 pupillary block) and 15 minor complications (7 cystoid macular edema, 1 anterior uveitis, 6 elevated intraocular pressure >35 mm Hg, 1 vitreous plugging of glaucoma drainage implant) were attributed to the dislocated intraocular lens. There was no significant association between complication risk and cataract surgery timing, prior pars plana vitrectomy status, and intraocular lens type. Sixty-four eyes (18.6%) never underwent intraocular lens repair; none of these eyes developed complications. Conclusions: The rate of major complications with posteriorly dislocated intraocular lenses was low. Most complications occurred within 90 days of dislocation. In select patients with medical or ocular comorbidities in whom intraocular lens repair may neither be safe nor significantly improve vision, it may be reasonable to forego or delay surgical intervention, although close monitoring is advisable, especially in the first 2 months after intraocular lens dislocation.