Risk Factors for Intraocular Lens Dislocation Requiring Surgical Intervention After Initial Phacoemulsification Cataract Surgery

Background/Aims: To identify pre-, intra-, and postoperative risk factors for developing IOL dislocation that required surgical intervention for IOL dislocation after an initial planned phacoemulsification cataract surgery. Methods: A retrospective multicenter clinical database study collected over 12 years from 8 clinical centers in the United Kingdom. We included all eyes that underwent planned phacoemulsification cataract surgery. We excluded eyes that underwent planned large incision cataract surgery, were left aphakic during initial surgery and those that underwent retina or other intraocular surgery between initial cataract surgery and development of IOL dislocation. We used the Poisson model with robust approximation of variance for multivariable estimations to calculate adjusted relative risk (ARR). Results: Of 176,572 eyes that underwent planned phacoemulsification cataract surgery, 145 (0.08%) developed IOL dislocation requiring surgery. Factors that increased the risk for developing IOL dislocation included age between 18 and 40 years (ARR = 4.5 1.7– 12.0), age between 40 and 60 years (ARR = 2.6 1.6– 4.5), male sex (ARR = 1.5 1.1– 2.1), pseudoexfoliation (ARR = 5.7 3.1– 10.5), zonular dialysis (ARR = 3.3 1.5– 7.1), posterior capsule rupture (PCR) (ARR = 16.4 9.7– 27.1), iris damage (ARR = 4.2 1.5– 11.6), combined phacoemulsification-pars plana vitrectomy (ARR = 3.2 1.7– 6.2), and YAG capsulotomy (ARR = 2.8 1.5– 5.2) (p < 0.05 for all). Conclusion: This large database study quantified the risk factors for IOL dislocation after cataract surgery. This information is clinically useful for surgeons for preoperative risk stratification and surgical planning. Keywords: intraocular lens dislocation, phacoemulsification, pseudoexfoliation, posterior capsule rupture, zonular dialysis, vitrectomy, capsulotomy