Comparative Functional and Morphological Data of Different IOL Dislocation Undo Methods

Background: /Objectives: This study compared the results of iris-sutured, late spontaneously dislocated IOL-capsular bag complexes with IOL exchange using anterior chamber intraocular lenses (ACIOL) in a tertiary reference center in Lithuania. Methods: A prospective observational study was conducted between 2017 and 2019 involving 80 patients (83 eyes) with late spontaneous IOL-capsular bag dislocation. Patients underwent repositioning and fixation of the dislocated IOL to the iris (IF group) or IOL exchange with an ACIOL implant (ACIOL group). Pre- and postoperative assessments included best-corrected distance visual acuity (BCDVA), intraocular pressure (IOP), corneal endothelial cell density (ECD), and macular thickness (evaluating whether cystoid macular edema (CME) has occurred). Results: Both groups showed a significant improvement in BCDVA, with a more remarkable improvement in the IF group (median: 0.1 logMAR) than in the ACIOL group (median: 0.3 logMAR), p=0.001. Corneal astigmatism increased significantly in the ACIOL group (p<0.001) but remained stable in the IF group. IOP management outcomes were better in the IF group as fewer eyes required additional glaucoma treatment. ECD decreased in both groups but was significantly greater in the ACIOL group (p<0.001). Postoperative CME occurred in 4.4% of IF eyes and 39% of ACIOL eyes (p=0.01). Conclusions: Iris fixation of late dislocated IOL-capsular bag complexes is a safe and minimally invasive technique that offers better visual outcomes, less astigmatism, and fewer complications than ACIOL exchange.