"The ophthalmologist should determine what is the underlying cause of the dislocation, and if it's likely to be progressive," Dr. In these latter cases, surgery is more elective than urgent, says Dr. IOL dislocation following trauma is a different situation, says Dr. "The patient has an injury, a certain amount of damage is done, but it tends not to be progressive," he explains.Trauma is the other side of the coin from capsule constriction and zonulysis due to pseudoexfoliation or a related disorder.Masket notes that it is possible for the ophthalmologist to be the first person to notice a dislocation in an asymptomatic patient.Even if the decentration is not a problem to the patient, the surgeon may recognize it as potentially serious. If the patient has a large defect in the zonules or in the capsule, a lens can dislocate into the posterior segment rapidly." Conversely, a patient could be symptomatic with a dislocated lens that's in a relatively stable condition.It's generally necessary to remove the implant from the capsular bag because the bag has accumulated regenerating lens material" (e.g. "Unless one removes that material," he says, "there's potential for it to be liberated within the eye, potentially inducing inflammation and elevating intraocular pressure." Dr.

In cases where one haptic is well-positioned in either the sulcus or the capsule bag, and just one loop is free, Dr.

But now, in some cases, we note that the anterior capsular remnant undergoes fibrometaplasia with potential phimosis and zonular instability." Among those patients at greater risk for capsular phimosis and fibrosis post-surgery are those with pseudoexfoliation syndrome, followed by patients with chronic anterior segment inflammation or uveitis, retinitis pigmentosa, myotonic dystrophy, some patients with diabetes, and post-vitrectomy patients. Masket names those with a chronic breakdown in the blood-aqueous barrier.

Patients with any of these conditions should be followed carefully postop for signs that the capsule is contracting.

"If one notes significant constriction, I strongly recommend using the Nd: YAG laser to create radial relaxing incisions in the anterior capsule to reduce the effect of the centripetal fibrotic traction," he instructs.

Certainly, however, there are other causes of malpositioned IOLs.

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