Management of dislocated posterior chamber intraocular lenses using pars plana vitrectomy combined with insertion of an anterior chamber lens

Purpose: Since anterior chamber intraocular lenses (ACIOL) are technically easier to implant than sutured posterior chamber intraocular lenses (PCIOL), we sought to determine the efficacy and safety of combining pars plana vitrectomy for removal of dislocated PCIOL'S with insertion of open-loop, flexible ACIOL's. Methods: The records of all cases of dislocated PCIOL'S managed at the Medical College of Wisconsin from November 1991 thru November 1996 were reviewed. Postoperative results were evaluated. Results: Eight patients (4 men and 4 women) underwent primary PCIOL removal with ACIOL implantation. One additional woman underwent a secondary ACIOL procedure when her sutured PCIOL redislocated. Best corrected visual acuity improved in 5 cases, was unchanged in 2, and declined in 2 (Average follow-up 57 weeks). F inal post-operative visual acuity was better than 20/40 in 5 cases, while chronic ocular disease (age-related macular degeneration (1), rctinitis pigmcntosa (1), chronic cystoid macular edema (2)) limited final vision in the remaining patients. There was one hyphema and one vitreous hemorrhage postoperativcly, both of which cleared without visual compromise. There was no evidence of coraeal compromise or exacerbation of glaucoma. Conclusions: Given that results and complication rates appear similar in this small series, implantation of an ACIOL after removal of a dislocated PCIOL appears to be a viable alternative to scierai fixation of a dislocated PCIOL.