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Impact of intraocular lens characteristics on intraocular lens dislocation after cataract surgery
  1. Christoph Fidel Mayer-Xanthaki1,
  2. Gudrun Pregartner2,
  3. Nino Hirnschall3,
  4. Thomas Falb1,
  5. Michael Sommer1,
  6. Oliver Findl3,
  7. Andreas Wedrich1
  1. 1 Department of Ophthalmology, Medical University of Graz, Graz, Austria
  2. 2 Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria
  3. 3 VIROS - Vienna Insitute for Research in Ocular Surgery, Hanusch Hospital, Vienna, Austria
  1. Correspondence to Christoph Fidel Mayer-Xanthaki, Department of Ophthalmology, Medical University Graz, Auenbruggerplatz 4, Graz AT-8036, Austria; christoph.mayer{at}


Background To assess the influence of intraocular lens (IOL) characteristics on IOL dislocations after cataract surgery.

Methods Patients who underwent cataract surgery at the Department of Ophthalmology Graz, Austria, between 1996 and 2017 were included and medical records were reviewed. Cox proportional-hazard regression models were used to assess the influence of IOL characteristics on IOL dislocation.

Results From 68 199 eyes out of 46 632 patients (60.2% women, mean age: 73.71 SD±10.82 years), 111 (0.16%) had an in-the-bag (ITB) disloaction and 35 (0.05%) had an out-of-the-bag (OTB) dislocation. The HRs adjusted for predisposing factors significantly associated with a higher risk for an ITB dislocation were 2.35 (95% CI, 1.45 to 3.8) for hydrophilic IOLs, 2.01 for quadripode IOLs (95% CI, 1.04 to 3.86) and 1.61 (95% CI, 1.04 to 2.48) for haptic angulation. A lower risk was observed for three-piece IOLs (HR=0.58, 95% CI, 0.34 to 0.98) and larger overall IOL diameter (HR=0.79, 95% CI, 0.66 to 0.95). For an OTB dislocation, the HR associated with a higher risk was 18.81 (95% CI, 5.84 to 60.58) for silicone IOLs and 2.12 (95% CI, 0.62 to 7.29) for hydrophilic IOLs. Larger overall IOL diameter (HR 0.40, 95% CI; 0.25 to 0.63) showed a lower risk.

Conclusion Hydrophilic IOLs, quadripode IOLs and haptic angulation were associated with a higher risk for an ITB dislocation, whereas three-piece IOLs and a larger overall diameter were associated with a lower risk. Risk factors for OTB dislocation were silicone IOLs, hydrophilic IOLs and a smaller overall IOL diameter.

  • Lens and zonules
  • Treatment Surgery

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  • Contributors CFM-X, GP and NH: research design, data acquisition and analysis, interpretation of data, drafting the manuscript and critical revision of the manuscript. TF and MS: data acquisition and analysis, critical revision of the manuscript. OF and AW: research design, interpretation of data and critical revision of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests NH is a research advisor to Carl Zeiss Meditec and Hoya Surgical. OF is a research advisor to Alcon, Croma, Carl Zeiss Meditec AG, Johnson & Johnson and Merck.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request. All data relevant to the study are included in the article or uploaded as supplemental information.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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