Out-Of-The-Bag Intraocular Lens Dislocation in Dead Bag Syndrome and Its Association With Eye Rubbing

To describe clinical features, risk factors and outcomes of out-of-the-bag (OTB) intraocular lens (IOL) dislocation in dead bag syndrome (DBS).

Retrospective review of a single-surgeon series of eyes with IOLs that developed OTB IOL dislocation, managed at Singapore National Eye Centre (January 2014-December 2021), with a minimum of 6 months of follow-up. Eyes with OTB IOL dislocation following secondary IOL implantation and intraoperative capsule complications were excluded. Patient demographics, ocular history, clinical findings, ocular trauma/eye rubbing, surgical procedures and postoperative outcomes were obtained.

Fifty eyes (40 unilateral, 5 bilateral) of 45 patients were included. Patients were predominantly male (82.2%), presenting at 61.9 ± 14.1 years old, 11.2 ± 6.0 years after cataract surgery. Eye rubbing was the only form of ocular trauma (n = 34; 68.0%). Compared to non-eye rubbers, eye rubbers were significantly more likely to have elevated intraocular pressure (IOP) (32.4% vs. 6.2%; OR 10.9, 95% confidence interval [CI] 1.12-107; p = 0.040), larger posterior capsule defects (median 60% vs. 50%; p = 0.029), vitreous in the anterior chamber (38.2% vs. 6.2%; OR 10.3, 95% CI 1.05-101; p = 0.045) and lower endothelial cell counts than the non-affected eye (-145 ± 507 vs. 315 ± 639 cells/mm²; p = 0.026). The most common complications after IOL exchange were elevated IOP (n = 11; 22.0%) including glaucoma (n = 8; 16.0%) and recurrent IOL subluxation (n = 7; 14.0%).

Eye rubbing appears to play an important role in the development of OTB IOL dislocations in DBS and is associated with more severe clinical manifestations. Treating the underlying cause and counselling patients to avoid or minimise eye rubbing may reduce this complication.