Clinical Features, Risk Factors, and Outcomes Following Surgery for Late Intraocular Lens Decentration in the Dead Bag Syndrome

• Published in: American journal of ophthalmology Vol. 272; pp. 38 - 47
• Main Authors: Nath, Vandana, Vasavada, Abhay R., Dholu, Suchi, Vasavada, Shail, Dwivedi, Shyamal, Shivnani, Bharti, Vasavada, Vaishali, Rajkumar, Sankaranarayanan, Srivastava, Samaresh
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.04.2025
• Subjects: Aged; Aged, 80 and over; Artificial Lens Implant Migration - diagnosis; Artificial Lens Implant Migration - etiology; Artificial Lens Implant Migration - surgery; Device Removal; Female; Humans; Lens Implantation, Intraocular; Lenses, Intraocular; Male; Middle Aged; Phacoemulsification; Posterior Capsular Rupture, Ocular - diagnosis; Posterior Capsular Rupture, Ocular - surgery; Postoperative Complications; Prospective Studies; Reoperation; Risk Factors; Syndrome; Treatment Outcome; Visual Acuity - physiology; Vitrectomy
• ISSN: 0002-9394; 1879-1891; 1879-1891
• DOI: 10.1016/j.ajo.2025.01.008

To evaluate demographic profile, risk factors, and outcomes following intraocular lens (IOL) exchange surgery for late decentration of IOLs in dead bag syndrome Prospective, interventional case series This was a study conducted at Raghudeep Eye Hospital, India. Explantation of the decentered/dislocated IOL along with pars plana vitrectomy and intrascleral fixation of a 3-piece foldable IOL using the Yamane technique was performed for all eyes. A total of 46 eyes (43 patients) with late decentration/dislocation of IOLs and spontaneous posterior capsule rupture in a clear and relatively intact capsular bag were treated. None of the eyes had significant zonular weakness. The main outcome measures were demographic profile, associated risk factors, visual outcomes and postoperative complications following IOL exchange in dead bag syndrome. A total of 30 eyes had in-the-bag IOL decentration and 16 had total dislocation of the IOL into the vitreous cavity. The mean (SD) age was 68.7 ± 8.9 years, and 91% patients were male. Of the patients, 36 had unilateral IOL disease, whereas 7 had bilateral dead bag syndrome, with or without clinically significant IOL decentration. The mean duration from primary cataract surgery to re-operation was 16.8 years. More than 50% eyes had axial myopia (axial length >24 mm). Only 4 eyes (9.3%) had associated pseudoexfoliation. Mean (SD) follow-up after IOL exchange surgery was 10.9 ± 9.8 months. The single-piece hydrophobic acrylic IOL was the most commonly explanted IOL. Intraoperatively, a Soemmering ring was seen in 71.7% (31) eyes. Of the eyes, 87% had an improvement in corrected-distance visual acuity (CDVA) following surgery, with 95% of eyes having a CDVA of ≤0.3 logMAR. Postoperative complications were a transient IOP spike in 8 (17%) eyes and cystoid macular edema in 6 eyes (13%). Three eyes had pre-existing glaucoma, which remained controlled at final follow-up. The major risk factors for dead bag syndrome were male sex, axial myopia, and duration of posterior capsule rupture event from the cataract surgery. Bilaterality and presence of the Soemmering ring in the majority of cases were new observations warranting further research. Outcomes following surgery were satisfactory. •Dead bag syndrome is a distinct clinical entity responsible for late decentration of intraocular lenses (IOLs) following uneventful in-the-bag IOL implantation. Here there is a spontaneous posterior capsule rupture with a diaphanous clear capsule bag that remains in situ with total or partial anchorage.•This syndrome occurs predominantly in male individuals and has a strong association with axial myopes.•The syndrome can often be a bilateral disease, raising questions regarding possible genetic associations.•Duration from the primary cataract surgery increases the risk of dead bag syndrome. Counseling patients undergoing cataract surgery and keeping them under lifetime follow-up is recommended.