Intraocular Lens Dislocation
Conditions
Keywords
IOL dislocation, Cataract, Cataract surgery, Scleral suturing, Verisyse, Iris-claw, Late in-the-bag IOL dislocation
Brief summary
Overall aim of the study is to compare the safety and efficacy of two different surgical methods to treat Late In-the-bag intraocular lens dislocation.
Detailed description
Cataract is a condition of unclear lens that cause poor vision. The only treatment is surgery where the blurred biological lens is replaced with an artificial clear lens (IOL). Most people who operate achieve full vision. Nevertheless, serious complications may occasionally occur, and one of these is dislocation of the entire complex with IOL and lens capsule. This requires surgical treatment. In this study the investigators want to compare two different surgical methods used in late dislocation of IOL inside the capsule after cataract surgery. Patients will be randomly affiliated to either the suturing of existing IOL / capsule complex, or lens exchange to an IOL fixed to the iris. The focus of the trial will be especially on complications and other eye changes in the early stages of surgery. Today, little data is available on these topics, and the investigators believe that new knowledge can bring us closer to a response to preferred operating techniques and an optimal drug drop regime for the patient group.
Interventions
PROCEDUREIOL repositioning
Intraocular lens repositioning by scleral suturing
PROCEDUREIOL exchange
Intraocular lens exchange with retropupillary iris-claw lens
Sponsors
South-Eastern Norway Regional Health Authority
Oslo University Hospital
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Outcomes Assessor)
Masking description
Masking of research optometrists to group affiliation at the postoperative examinations will be endeavored. A physician will perform slit lamp examinations at the postoperative visits, hence he/she cannot be masked, nor can the surgeon. The investigator will be masked during the image analysis.
Intervention model description
Randomized clinical trial
Eligibility
Sex/Gender
ALL
Healthy volunteers
No
Inclusion criteria
* IOL inside the capsule (in-the-bag) * Late dislocation (more than 6 months after cataract surgery) * IOL visible in the pupillary area in the supine position and hence possible to perform surgery with an anterior approach * Eligibility for both operation methods * Ability to cooperate fairly well during the examinations * Willing to participate in the study, e.g. willingness to participate at all control visits
Exclusion criteria
* IOL designs that cannot be repositioned with a suture loop, such as plate-haptic IOLs without holes in the peripheral part * Eyes with especially thin sclera * Active uveitis or pronounced iris pathology * Eyes with previously performed Descemet's Stripping Automated Endothelial Keratoplasty (DSAEK) * Totally dislocated IOL into the posterior segment of the eye requiring pars plana vitrectomy * Eyes that prior to cataract extraction had a subluxated lens in need of surgery with a Cionni capsular tension ring (e.g. patients with Marfan syndrome and ectopia lentis) * Cases requiring a change in refraction. Risk of severe anisometropia * Patients unable to lie in supine position for surgery in local anesthesia, e.g. severe chronic obstructive pulmonary disease and severe heart failure * Patients using anticoagulants that cannot be discontinued For patients with dislocated IOLs in both eyes during the study period, only the first operated eye will be included. Patients without prospects of improvement in vision will be excluded.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Inflammation in the anterior chamber after surgery | The first weeks after surgery | Measured with a Laser Flare Meter |
| Changes in macular thickness and occurrence of Cystoid macular edema | The first months after surgery, and long term changes months up to two years after surgery | Evaluated with Optical Coherence Tomography |
| Intraocular pressure changes | Early changes in the first weeks after surgery, and long term changes months up to two years after surgery | Measured with Goldmann Applanation Tonometry and iCare, both measured in mmhg |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Intra- and postoperative complications | Short term and long term (first post operative day, the first weeks and months, and up to two years) | All relevant complications |
| IOL tilt | 6 months and 2 years | Measured with anterior segment Ultra Sound |
| Best Corrected Visual acuity (BCVA) | Short term (the first weeks and up to 6 months) and long term (up to two years) | Measured in LogMar |
| Astigmatism | Short term - meaning 2 weeks to 6 months. Long term - meaning up to two years | To compare astigmatism measured by keratometry |
| Refractive outcomes - subjective refraction measured with a phoropter | Short term - meaning 2 weeks to 6 months. Long term - meaning up to two years | To compare the refractive outcomes (short and long-term) |
| Glare | Medium term (6 months) | Measured by straylight meter |
| Endothelial cells | Short term (2 weeks) and long term (6months and 2 years) | Measured by Non-contact corneal confocal microscopy |
Countries
Norway
Contacts
Primary ContactMarius Dalby, M.D. PhD Cand.
Outcome results
None listed