Surgical strategies for intraocular lens dislocation in glaucoma patients

PURPOSE. To conduct a comparative analysis of clinical outcomes of repositioning with transscleral suturing of the intraocular lens (IOL) versus a combined approach involving non-penetrating deep sclerectomy with implantation of the Collagen Antiglaucoma Drainage Xenoplast (NPDS+CAD).
METHODS. This study is retrospective analysis of 51 medical records of patients with clinically significant IOL dislocation. Follow-up was conducted on postoperative day 1, and at 1, 3, and 6 months. The following parameters were evaluated: uncorrected and best-corrected visual acuity (UCVA and BCVA), intraocular pressure (IOP), number of antiglaucoma medications, success rate, and number of complications.
RESULTS. Patients were divided into two groups: group I — IOL repositioning with transscleral fixation (38 patients); group II — combined NPDS+CAD and IOL repositioning with transscleral fixation (13 patients). UCVA and BCVA showed no statistically significant differences between groups throughout the follow-up period (p>0.05). Preoperative IOP was 19.94±7.82 mm Hg and 32.65±11.51 mm Hg (p<0.05); medication load was 0.76±0.94 and 2.69±0.63 (p<0.05) in groups I and II, respectively. At 6 months, IOP was 17.29±5.59 mm Hg in group I (13.3% reduction), and 14.98±6.68 mm Hg in group II (54.1% reduction). Medication load was 1.17±1.68 and 1.54±1.39, respectively. No intergroup differences were observed at 6 months (p>0.05). Complete success was achieved in 33% and 8%, partial success in 33% and 62%, and failure in 14% and 15% of cases in groups I and II, respectively. No cases of shallow anterior chamber were reported in the early postoperative period. There were 4 cases of hyphema ≤1 mm (3 in group I, 1 in group II) and 4 cases of partial vitreous hemorrhage (3 in group I, 1 in group II), all of which resolved on its own. In group I, 4 patients (10.5%) required staged NPDS+CAD within 2.8±4.2 months due to IOP elevation up to 35.5±6.3 mm Hg.
CONCLUSION. The combination of IOL repositioning with transscleral fixation and NPDS+CAD for IOL dislocation in the setting of ocular hypertension demonstrates a high efficacy and safety profile, comparable to stand-alone IOL transscleral fixation in eyes with normalized IOP.

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