Risk factors for late intraocular lens dislocation: a systematic review and meta-analysis

To quantify associations between potential risk factors and late intraocular lens (IOL) dislocation after uncomplicated phacoemulsification with IOL implantation.

Late IOL dislocation is an uncommon but clinically important long-term complication of cataract surgery. Although several predisposing conditions have been described, their relative contribution has not been comprehensively quantified.

A systematic review and meta-analysis were performed according to PRISMA. The study protocol was prospectively registered on PROSPERO (CRD420261328390). MEDLINE, Google Scholar, ScienceDirect, and Cochrane Library were searched for English- and Russian-language studies published from 2000 to 2025. Comparative observational studies were included in the meta-analysis; additional non-comparative studies were used for descriptive synthesis of prevalence data. Risk of bias was assessed with the Newcastle-Ottawa Scale. Random-effects models were used to pool odds ratio (OR) with 95% confidence interval (CI).

Eight comparative studies were included in the meta-analysis and 28 non-comparative studies in descriptive synthesis. The strongest associations were found for zonular weakness (OR 8.04, 95% CI 5.27-12.28), ocular trauma (OR 5.98, 95% CI 2.16-16.52), uveitis (OR 5.73, 95% CI 2.23-14.68), and pseudoexfoliation syndrome (OR 5.72, 95% CI 3.23-10.15). Myopia (OR 3.32, 95% CI 1.38-7.97) and glaucoma (OR 2.60, 95% CI 1.46-4.60) showed moderate associations, whereas previous vitrectomy and male sex were not statistically significant.

Late IOL dislocation is most strongly associated with structural and inflammatory damage to the capsular-zonular complex. High prevalence of a factor among cases does not necessarily indicate independent pathogenetic significance.