Regional EuroTimes
Date Posted 14/09/2009
Phaco may increase incidence of IOL subluxation
The near universal adoption of phacoemulsification for cataract procedures has resulted in an increased rate of IOL subluxation in Sweden, said Ulf Stenevi MD, Sahlgrenska University Hospital, Mölndal Sweden.
“We are seeing an increase in the number of patients needing a second surgery. We hadn’t seen these before we have a pretty good idea of which patients are at risk and the question we need to answer is, is phacoemulsification the better surgery for all eyes for all cataracts all surgeons all the time?” said Dr Stenevi at the XXVII Congress of the ESCRS.
He noted that the Swedish registry of cataract surgeries in the western region of Sweden, which has a population of 1.5 million, the number of patients requiring repositioning and suturing of their IOLs has increased over five-fold since the general adoption of phacoemulsification in Sweden around the year 2000.
That is, while in the year 2000 IOL subluxations occurred in only 11 out of 57,000 patients with IOLs, there were 30 IOL subluxations among 92,000 patients with IOLs in 2005. If the frequency of the complication had remained stable between those two time points there would have only been 18 subluxations in 2005, Dr Stenevi pointed out.
Analysis of the patients’ records showed that the interval between surgery and the subluxations was generally around five years, strongly implicating the use of phacoemulsification as contributing factor.
Other surgical practices introduced around the same time include intraocular injection of antibiotics, anaesthetics and steroids. The effect of such injections on the ciliary zonule remains unknown, Dr Stenevi said.
Other risk factors identified included pseudoexfoliation or other concomitant eye disease, which was present in over half of patients with subluxated IOLs. In addition 35 per cent of patients had pre-existing glaucoma and 25 per cent had undergone previous surgery.
Moreover, the patients had a high rate of complications during their surgery, including zonular dehiscence, capsular rupture and postoperative IOP higher than 25 mmHg.
Fortunately, the re-positioning and suturing procedures appear to have a good outcome in general with little effect on the cornea, visual acuity or IOP. The main complications have been recurrent haemorrhages and an occasional retinal detachment.
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