The rise of foldable IOL dislocation and decentration

An update of the ESCRS and ASCRS survey on the most common complications involving foldable IOLs.

How do the IOLs compare to each other?

The hydrophilic acrylic IOLs and the one-piece hydrogel IOLs stand apart from the other IOL types, in that they are associated with a much different kind of complication. Calcification or damage to the IOL in the three-piece design is the most common reason for these lenses to be removed while the one-piece hydrogel lenses often sustain damage because, as Dr Mamalis explains, they are more fragile than other lenses. Complications with multifocal silicone IOLs are evenly split between dislocation/decentration and incorrect lens power.

Disturbing trends emerged

The investigators have also noticed some continuing and disturbing trends over the eight years that the survery has been running, as well as some interesting differences. "Because the three-piece silicone IOLs have been evaluated in all the surveys, when we looked at them we found that the rate of dislocation/decentration has increased markedly," Dr Mamalis pointed out. "The other complications, such as damage to the IOL and incorrect lens power, have been decreasing with time."

The three-piece hydrophobic acrylic lenses are showing a similar trend with an increase in the rate of dislocation/ decentration and a decrease in glare, incorrect lens power and visual aberrations. Glare and optical aberrations were complaints often associated with the early hydrophobic lenses, but the incidence of these complications is decreasing. The rate of dislocation/decentration for one-piece plate silicone IOLs is also increasing with each survey.

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