Risk factors for intraocular pressure elevation in eyes with intraocular lens subluxation or dislocation

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PURPOSE: To investigate the risk factors for intraocular pressure (IOP) elevation in eyes with intraocular lens (IOL) subluxation or dislocation. METHODS: We retrospectively examined the eyes with IOL displacement (either IOL subluxation or IOL dislocation) who underwent IOL refixation combined with vitrectomy between September 1, 2012, and May 31, 2024, at Fukui University Hospital. Patients were divided into two groups: those with IOL subluxation and those with IOL dislocation. Additionally, subgroups were created for eyes without glaucoma and those without both glaucoma and exfoliation syndrome. IOL subluxation was defined as the movement of the IOL-capsular bag complex in the posterior chamber, while IOL dislocation was defined as a fall of the IOL-capsular bag complex into the vitreous space. Risk factors for preoperative IOP elevation in eyes with IOL displacement were identified using multivariate analysis with a multiple linear regression model. RESULTS: This study included 155 eyes with IOL displacement (IOL subluxation; 73 eyes and IOL dislocation; 82 eyes). Multivariate analyses revealed that IOL subluxation and the number of glaucoma medications were significantly associated with a higher preoperative IOP (P < 0.01). The preoperative IOP and the number of glaucoma medications were significantly higher in the IOL subluxation group than in the IOL dislocation group (22.7 ± 9.0 vs. 15.5 ± 3.9 mmHg, P < 0.01, and 1.2 ± 1.7 vs. 0.2 ± 0.8, P < 0.01, respectively). The number of patients with exfoliation syndrome and glaucoma was significantly higher in the IOL subluxation group than in the IOL dislocation group (49% vs. 10%, P < 0.01, and 25% vs. 7%, P < 0.01, respectively). In the subgroup analysis in eyes without glaucoma (131 eyes), IOL subluxation and the number of glaucoma medications were significantly associated with a higher preoperative IOP (P < 0.01). In this subgroup, the preoperative IOP and the number of glaucoma medications were significantly higher in the IOL subluxation group than in the IOL dislocation group (20.6 ± 8.5 vs. 15.5 ± 3.9 mmHg, P < 0.01, and 0.4 ± 1.0 vs. 0.04 ± 0.3, P < 0.01, respectively), and the incidence of exfoliation syndrome was significantly higher in the IOL subluxation group than in the IOL dislocation group (40% vs. 8%, P < 0.01). In another subgroup analysis in eyes without glaucoma and exfoliation syndrome (103 eyes), IOL subluxation and the number of glaucoma medications were significantly associated with a higher preoperative IOP (P < 0.01). In this subgroup, the preoperative IOP and the number of glaucoma medications were significantly higher in the IOL subluxation group than in the IOL dislocation group (19.3 ± 7.3 vs. 15.7 ± 4.0 mmHg, P = 0.049, and 0.3 ± 0.9 vs. 0.0 ± 0.0, P < 0.01, respectively). CONCLUSIONS: IOL subluxation, but not dislocation, is a risk factor for elevated IOP in eyes with IOL displacement.

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