Department of Ophthalmology, Institute of Vision Research, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonjuro, Gangnam-gu, Seoul, 06273, Republic of Korea.
Department of Ophthalmology, Institute of Vision Research, Severance Hospital, Yonsei University College of Medicine, 134 Shinchon-dong, Seodaemun-gu, Seoul, Republic of Korea.
BMC Ophthalmol. 2024 Aug 26;24(1):375. doi: 10.1186/s12886-024-03621-4.
Posterior chamber intraocular lens (IOL) dislocation is a common complication of cataract surgery. Dislocated IOLs often require surgical intervention due to the potentially severe risks of leaving this condition untreated. If a patient with extremely low corneal endothelial cell density (ECD) presents with IOL dislocation, the surgeon faces a crucial dilemma of choosing the most optimal surgical treatment option. We sought to investigate the efficacy and safety of retropupillary iris claw intraocular lens (R-IOL) implantation in patients with IOL dislocation and extremely low (< 1000 cells/mm) ECD.
We retrospectively reviewed the medical records of nine patients (all men) whose pre-operative ECD was < 1000 cells/mm and who underwent R-IOL implantation due to intraocular subluxation or total dislocation into the vitreous cavity between 2014 and 2020. We evaluated corneal endothelial function and visual outcomes after surgery.
Nine patients were included in this study. The mean age at diagnosis was 64.89 ± 7.15 years (range 57-76 years), and the follow-up duration was 37.93 ± 23.72 months (range 18.07-89.07 months). No patients developed bullous keratopathy during follow-up. Compared to the initial ECD, corneal thickness (CT), coefficient variation of cell area (CV) and percentage of hexagonal cells (HEX), there was no statistically significant decrease in the ECD, CV, and HEX at last follow-up (P = 0.944, 0.778, 0.445, 0.443). There was significant improvement in the mean uncorrected distance visual acuity (UDVA) at the last follow-up (average 0.13 logMAR, 20/27 Snellen) compared to the pre-operative mean UDVA (average 1.09 logMAR, 20/250 Snellen) (P < 0.01).
R-IOL implantation did not result in a statistically significant decline in corneal endothelial function in patients with preoperatively low ECD, and it significantly improved the mean UDVA postoperatively. R-IOL implantation appears to be a safe and effective treatment modality for intraocular lens dislocation in patients with low ECD (< 1000 cells/mm²); however, long-term follow-up studies are warranted to corroborate these findings.
后房人工晶状体（IOL）脱位是白内障手术的常见并发症。由于不治疗这种情况可能带来严重风险，因此通常需要手术干预。如果患有极低角膜内皮细胞密度（ECD）的患者出现 IOL 脱位，那么外科医生在选择最佳手术治疗方案时会面临一个关键的困境。我们旨在研究在 ECD 极低（<1000 个细胞/mm²）的 IOL 脱位患者中使用后房虹膜夹型 IOL（R-IOL）植入的疗效和安全性。
我们回顾性分析了 2014 年至 2020 年间，因晶状体眼内半脱位或完全脱位至玻璃体腔而接受 R-IOL 植入术的 9 名男性患者（均为男性）的病历，这些患者术前 ECD<1000 个细胞/mm²。我们评估了手术后的角膜内皮功能和视力结果。
本研究纳入 9 名患者。诊断时的平均年龄为 64.89±7.15 岁（57-76 岁），随访时间为 37.93±23.72 个月（18.07-89.07 个月）。随访期间，没有患者发生大泡性角膜病变。与初始 ECD 相比，角膜厚度（CT）、细胞面积系数变异（CV）和六边形细胞百分比（HEX）在末次随访时均无统计学意义的降低（P=0.944、0.778、0.445、0.443）。末次随访时，平均未矫正远视力（UDVA）较术前有显著改善（平均 0.13 logMAR，20/27 Snellen）（P<0.01）。
对于术前 ECD 较低的患者，R-IOL 植入术并未导致角膜内皮功能的统计学显著下降，并且术后明显改善了平均 UDVA。对于 ECD 较低（<1000 个细胞/mm²）的患者，R-IOL 植入术似乎是一种安全有效的治疗晶状体脱位的方法；但是，需要进行长期随访研究来证实这些发现。
