Late In-The-Bag IOL Displacement Risk Greater For Patients With High Flare, IOP

Delayed in-the-bag intraocular lens dislocation may be caused by preoperative inflammation.

Late in-the-bag IOL displacement is more likely in eyes with greater preoperative anterior chamber flare and higher intraocular pressures (IOP), according to a report published in Acta Ophthalmologica.

A team of investigators evaluated the preoperative clinical characteristics of eyes that go on to develop late in-the-bag IOL displacement.

The analysis is part of a prospective trial; late in-the-bag intraocular lens dislocation surgery (LION; NCT03276104) that explored correcting lens position via scleral sutures or replacement with retropupillary iris-claw IOL. In the study involved 76 eyes of 76 participants (mean age, 79.7±7.2 years; mean time from IOL implantation 10.8±5.9 years). The researchers assessed inflammation using laser flare photometry. They defined 3 grades of subluxation:

  • 1. An IOL remains over the visual axis;
  • 2. Signifies an optic’s equator is close to the axis;
  • 3. The IOL-capsule complex is partially seen in the dilated pupil.

Median preoperative flare measured 21.5 (range 5.4 to 135.7) photon counts per millisecond (pc/ms) in eyes that developed a dislocated IOL vs 14.1 (2.0 to 42.9) pc/ms of the other eye (P <.001). Case eyes with grade 1 subluxation presented preoperative median flare of 24.6 (5.4 to 135.7) pc/ms, compared with grade 2 eyes exhibiting 19.6 (6.5 to 41.5) pc/ms (P =.06). Grade 3 eyes showed similar flare of 19.4 (10.2 to 53.5) pc/ms.

This suggests that inflammation is part of the clinical picture of late in-the-bag IOL dislocation.

The researchers explain that it remains unknown whether flare contributes to displacement, or subluxation prompts inflammation. “However, considering that the flare level in the dislocation eyes was higher than the fellow eyes, a clinical implication of the current study could be that the presence of low-grade inflammation strengthens the indication for surgery in eyes with dislocation grade 1 as this may otherwise be postponed in some patients with minimal visual complaints,” according to the study. “This suggests that inflammation is part of the clinical picture of late in-the-bag IOL dislocation.”

Case eyes’ IOP proved higher than contralateral eyes (P <.001). Previous analyses have indicated that increased IOP can occur with minor subluxation due to an IOL-capsule complex rubbing against the iris, but is followed by reduced friction upon additional dislocation.

The study was limited in that it excluded individuals who had prior or existing fellow eye IOL displacement.

Disclosures: One study authors declared affiliations with the biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.


Medin H, Kure ISH, Dalby M, Kristianslund O, Drolsum L. Inflammatory reaction in eyes with late in-the-bag intraocular lens dislocation. Acta Ophthalmologica. Published online on June 11, 2023. doi:10.1111/aos.15720