Clinical Features, Risk Factors and Outcomes following Surgery for Late Intraocular Lens Decentration in the Dead Bag Syndrome.

Purpose: To evaluate demographic profile, risk factors and outcomes following intraocular lens (IOL) exchange surgery for late decentration of IOLs in the dead bag syndrome DESIGN: Prospective, interventional case series PARTICIPANTS: 46 eyes (43 patients) with late decentration/dislocation of IOLs and spontaneous posterior capsule rupture in a clear and relatively intact capsular bag. None of the eyes had significant zonular weakness.

Methods: Study conducted at Raghudeep Eye Hospital, India. Explantation of the decentered/dislocated IOL along with pars plana vitrectomy and intrascleral fixation of a three-piece foldable IOL using the Yamane technique was performed for all eyes.

Main Outcome Measures: Demographic profile, associated risk factors, visual outcomes and postoperative complications following IOL exchange in dead bag syndrome.

Results: Thirty eyes had in-the-bag IOL decentration and 16 had total dislocation of the IOL into the vitreous cavity. The mean age was 68.7 ± 8.9 (standard deviation, SD) years and 91% patients were males. 36 patients had unilateral IOL disease, whereas 7 had bilateral dead bag syndrome, with or without clinically significant IOL decentration. The mean duration from primary cataract surgery to re-surgery was 16.8 years. More than 50% eyes had axial myopia (axial length > 24mm). Only 4 eyes (9.3%) had associated pseudoexfoliation. Mean followup after IOL exchange surgery was 10.9 + 9.8 (SD) months. The single piece hydrophobic acrylic IOL was the most commonly explanted IOL. Intraoperatively, Soemmering's ring was seen in 71.7% (31) eyes. Eighty-seven % eyes had an improvement in corrected distance visual acuity (CDVA) following surgery, with 95% eyes having a CDVA of ≤0.3 LogMAR. Postoperatively, following complications were seen - transient IOP spike in 8 (17%) eyes and cystoid macular edema in 6 eyes (13%). Three eyes had a pre-existing glaucoma, which remained controlled at final followup.

Conclusion: The major risk factors for the dead bag syndrome are male gender, axial myopia and the duration of posterior capsule rupture event from the cataract surgery. Bilaterality and presence of Soemmering's ring in majority of the cases are new observations, warranting further research. Outcomes following surgery are satisfactory.