Risk factors of late intraocular Lens displacement: A multi-national study

Purpose To examine potential risk factors of late intraocular lens displacement (LIOLD); a rare complication of cataract surgery believed to be due to progressive zonular insufficiency which is often managed with pars plana vitrectomy (PPV) and intraocular lens (IOL) exchange. Setting 16 centers across the UK, Germany and Greece Design Retrospective case control study Methods Cases of LIOLD occurring between June 2018 and January 2023 were identified. Demographics, biometry data, previous medical and ocular history were interrogated and multivariate logistic regression was performed. Results 434 eyes experiencing LIOLD were identified. 20,321 eyes not experiencing LIOLD during the same period formed the control group. Following multivariate analysis, YAG capsulotomy (OR 17.17, 95% CI 12.44–23.70, p < 0.001), pseudoexfoliation (OR 15.63, 95% CI 10.78–22.64, p < 0.001), complicated cataract surgery (OR 17.60, 95% CI 12.94–23.95, p < 0.001), previous PPV (OR 4.86, 95% CI 3.50–6.75, p < 0.001), younger age at cataract surgery (OR 0.94, 95% CI 0.93–0.95, p < 0.001) and axial myopia (OR 1.16, 95% CI 1.09–1.24, p < 0.001) were identified as risk factors. Female sex was associated with reduced risk (OR 0.64, 95% CI 0.51–0.80, p < 0.001). Patients having cataract surgery under 60 years had an increased risk (40 years OR 2.90, 30 years OR 4.92). Conclusion Risk factors are known to vary by geographical location and our study being the first multinational study provides a significant contribution. Future studies may look at prevention for at-risk individuals and compare outcomes of different IOL fixation techniques.