Long-term Results after Removal of Dislocated Intraocular Lenses from the Retinal Surface through a Limbal Approach

Background: The authors describe the use of a limbal approach for removing dislocated intraocular lenses (IOLs) from the retinal surface to minimize surgical trauma and optimize visual outcome. Methods: Thirteen consecutive patients underwent removal of a dislocated posterior chamber IOL (PC IOL) from the retinal surface through a limbal approach. The surgical technique used in all patients included a limbal incision from the 3- to 9-o'clock positions; open-sky vitrectomy, grasping the IOL at the angle between loops and optics with an iris hook; and IOL removal through the corneoscleral opening. In all except one patient, who had high-degree myopia, an IOL was re-implanted during the same surgical procedure (free sulcus fixation of a PC IOL over remnants of the capsular bag, 7 patients; sulcus fixation of a PC IOL over remnants of the capsular bag combined with 1 transscleral suture, 3 patients; and implantation of an anterior chamber IOL, 2 patients). Results: No retinal or corneal complications secondary to IOL removal and re-im-plantation through a limbal approach could be detected over an average follow-up period of 22.3 months (range, 17-27 months). Best-corrected visual acuity was 20/40 or better in seven patients, between 20/50 and 20/400 in three, and less than 20/400 in three. Visual outcome worse than 20/40 was related to pre-existing macular degeneration in five patients and retinitis pigmentosa in an additional one. Conclusions: The use of a limbal approach allows removal of an lOL from the retinal surface and secondary IOL implantation in the preferred site during the same surgical procedure. Because no special instrumentation is needed, this technique also is suitable for primary removal if dislocation occurs intraoperatively. The visual outcome and the long-term absence of complications recorded in our series indicate that a limbal approach may offer a reasonable alternative in managing IOLs luxated onto the retinal surface. © 1994, American Academy of Ophthalmology, Inc. All rights reserved.