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Glaucoma and Intraocular Pressure in Patients Operated for Late In-the-bag Intraocular Lens Dislocation: A Randomized Clinical Trial

Published:February 03, 2017DOI:https://doi.org/10.1016/j.ajo.2017.01.026

      Purpose

      To compare intraocular pressure (IOP) and IOP-lowering treatment requirements in patients with late in-the-bag intraocular lens (IOL) dislocation operated with 2 different methods, and to assess whether an IOP decrease after surgery can be expected.

      Design

      Prospective, randomized, parallel-group clinical trial.

      Methods

      In our university clinic, 104 patients (eyes) were randomly assigned to IOL repositioning by scleral suturing (n = 54) or IOL exchange with a retropupillar iris-claw lens (n = 50). The main outcome measure was 6-month postoperative IOP change.

      Results

      Overall IOP was 18.0 ± 6.2 mm Hg before surgery and 15.7 ± 4.8 mm Hg 6 months after surgery (P < .001). IOP changed by −1.2 ± 5.8 mm Hg (P = .18) in the Repositioning group and −3.8 ± 6.4 mm Hg (P < .001) in the Exchange group (group difference: P = .05). Before surgery, 62 patients had either preexisting glaucoma (n = 39) or high IOP (≥22 mm Hg) with suspected glaucoma (n = 23), of whom several required preoperative IOP-lowering treatment. In the postoperative period, 28% and 21% of the patients in each operation group, respectively, required IOP-lowering treatment with glaucoma medications added, adjunctive laser trabeculoplasty, cyclodiode laser, or filtering surgery. Only 0 and 3 patients, respectively, discontinued their IOP-lowering medication.

      Conclusions

      This trial showed an IOP decrease after late in-the-bag IOL dislocation surgery that seemed to be more pronounced with IOL exchange. However, associated high IOP was not resolved by dislocation surgery in many patients, and increased IOP-lowering treatment in the postoperative course was commonly required.
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