Although rare, a cataract lens implant can dislocate after surgery. Dislocations can occur in the early post-operative period of cataract surgery or even several years later. Any weakness to the zonular support structures or capsular bag that holds the lens implant can place a patient at risk for lens dislocation.

Symptoms of this condition include oscillopsia (jiggling vision), rapid shifts in focus, light sensitivity or photophobia and sudden loss of vision. Some patients even experience seeing the moon shape edge of the lens implant drifting out of their field of view. Besides trauma or previous vitreoretinal surgery, other risk factors include specific conditions, such as pseudoexfoliation syndrome, Marfan syndrome, Ehlers-Danlos Syndrome, high myopia and retinitis pigmentosa.

Over the past two decades, there have been remarkable advances in surgical techniques to repair and manage patients with dislocated lens implants.

If a lens is only partially out of position, or subluxed, we can surgically reposition and recenter it. Sutures may be needed depending on the status of the capsular support bag. If the capsular support bag is healthy, the lens implant can be captured inside the capsule without sutures. However, when there is poor capsular support, internal sutures are required to lasso the lens implant and anchor it securely inside the eye.

When the implant is completely dislocated posteriorly to the back of the eye by the retina, the surgical management is more complex and often staged with the help of a vitreoretinal surgeon. First, the damaged implant is lifted off the retina and explanted by a retina surgeon with careful attention to avoid potential for retina damage. Then, a new artificial lens implant can be placed as a secondary procedure.

Over 20 years ago, I remember working late into the night in surgery with
Gregg T. Kokame, MD with his haptic externalization techniques to suture secondary lens implants in aphakic patients. The Kokame technique was revolutionary for its time, but it would take several hours to perform with tedious internal suturing inside and outside the eye. Later, in the early 2000s, I worked with Howard V. Gimbel, MD, who at the time, published multiple surgical techniques of capsule fixation, optic capture and internal suturing that laid foundational concepts for further developments in the repair of lens dislocations and secondary lens implants after trauma. Other surgeons expanded on these concepts, and new techniques were popularized over the intervening years, including iris fixation, glued IOL (Agarwal, et al) and corneal-scleral (Hoffman) pockets.

These secondary lens surgical techniques were challenging to perform. Some surgeons would resort to older style surgical techniques of implanting an anterior chamber lens implant (ACIOL). Although using an ACIOL was a less complicated surgery to perform, it did require large incisions, multiple sutures and resulted in high post-operative astigmatism. Furthermore, the ACIOL techniques had increased rates of complications, such as corneal failure, chronic inflammation and UGH syndrome, that would often result in the need for additional surgeries.

In 2017, Shin Yamane, MD described a novel technique using small incisions and transscleral haptic fixation that revolutionized the field of secondary lens implant surgery. It is often performed without sutures and can be executed in less than an hour. This allows for much faster surgical times, lower complication rates and an easier recovery for patients. For these reasons, the Yamane technique is the preferred way to manage secondary lens implant surgery in patients with complete dislocated lens implants.

As for lens implant dislocations, the best advice is to avoid the problem altogether. Ensure that your eyes are safely protected when there is any potential risk of eye trauma. This is especially important when playing sports such as tennis and pickleball. An active, healthy lifestyle is an important part of living life to its fullest, and sports goggles should be a part of this too.

Dr. Tokuhara is a cataract surgeon with Desert Vision Center in Rancho Mirage and a member of Desert Doctors. He can be reached at (760) 340.4700. For more information visit www.desertvisioncenter.com