Even after a perfect cataract surgery, things can still go wrong. Life doesn’t always follow a perfect script. Having the new artificial lens dislocate inside the eye is one of those things. When this happens, however, there are a few very noticeable things.
The most common thing you may notice with a dislocated lens after cataract surgery is a sudden decrease in vision. But some other symptoms such as double vision are possible. This can occur at ANY time after cataract surgery - from months to years to even decades out. Fortunately this is rare, but certain individuals will be at a higher risk than others.
Let’s look at how this can even happen. But first, we have to learn exactly where the new artificial lens sits within the eye after cataract surgery. Let’s review some parts of the eye.
What Holds The Lens In Place
The lens inside our eye isn’t directly attached to the rest of the eye. Instead, the lens is attached via small supporting structures called suspensory ligaments or zonules. These zonules suspend the lens in place within the eye.
This unique feature actually allows the lens to easily change shape giving us the ability to focus up close when we are young.
But this lens isn’t even directly connected to these suspensory ligaments. This lens is contained within a bag called the capsule. This capsule is then connected to these suspensory ligaments.
Lens within capsule attached by suspensory ligaments within eye; image by File:Three Internal chambers of the Eye.png: Artwork by Holly Fischer derivative work: Pixelsquid, CC BY 3.0, via Wikimedia Commons / modified from original
This capsule becomes important during and after cataract surgery:
Once the lens becomes a cataract, it is removed through cataract surgery. However, this capsule is preserved. This capsule serves as a perfect spot to place the new artificial lens after cataract surgery. Like the natural lens before it, because it is inside the capsule the new artificial lens is also suspended and centered within the eye because of the suspensory ligaments.
When Can The Lens Dislocate
Sometimes these suspensory ligaments can be or become weak. If these support structures become too weak over time, it can no longer hold the artificial lens in place. The lens can then dislocate out of place.
Dislocated artificial lens; image shared thanks to Dr. Rafael Castañeda Diez
Unfortunately, this can happen at any time. This can happen months out from an uncomplicated cataract surgery. This can spontaneously happen decades out from cataract surgery!
Fortunately, this is quite rare. Up to twenty years out from cataract surgery, the risk of this occurring is less than 1%.
Not everyone is going to be at the same risk of the lens dislocating over time. Certain things will cause the suspensory ligaments to become weak and make someone much more predisposed to this than others:
- By far the biggest risk is a condition called pseudoexfoliation syndrome. This accounts for about 50% of the cases. This condition occurs most commonly in individuals with Scandinavian descent and the risk increases with age. It is generally asymptomatic and may not even be diagnosed until it is time for cataract surgery.
- Other connective tissues conditions such as Marfan’s syndrome also increase the risk.
- Trauma is another clear risk. Direct damage to the suspensory ligaments will most definitely make them weaker.
- Prior retina surgery
- High amount of nearsightedness
- Previous or recurrent inflammation or iritis inside the eye
- Diabetes
Having any of those conditions puts you at a greater risk than average of the lens spontaneously dislocating sometime after cataract surgery.
So how do you know if its happened?
How To Tell If Lens Dislocated After Cataract Surgery
It typically isn’t very subtle if the lens dislocates within the eye.
Good vision comes when the lens is sitting in the appropriate position within the eye. If the lens suddenly shifts position within the eye, vision will suddenly change.
Depending on how much the lens dislocated, this can range anywhere from a noticeable change in vision to a very large decrease in vision. If the lens moves completely out of the center of your vision, things will get typically get very blurry.
But in addition to a sudden decrease in vision, you may also notice double vision or glare. As the lens dislocates, it can tilt. This changes the way the lens focuses light in the back of the eye. Instead of light being perfectly in focus (like before), light can focus at multiple points causing you to see a shadowing double vision or scatter causing you to see more glare. You may even be able to see the edge of the lens in your vision.
Finally, when the lens moves out of position, it can interfere with the normal drainage of the fluid inside the eye. This can cause intermittent problems with pressure inside the eye. Or the lens can rub against and irritate other structures within the eye. Either of these can cause pain, blurred vision, red eye or headaches.
In any case, none of these symptoms are normal and any of them warrant a trip to your eye doctor for further investigation.
So What Can Be Done?
If the lens dislocates in the eye, there is hope for a fix. But most likely it will require surgery.
Placing a new artificial lens in the capsule isn’t the only way a lens can be placed within the eye. (which is good since when the suspensory ligaments are weak, the capsule can't support a lens anymore).
In many cases, the artificial lens can actually be sewn in place. Sewing the lens in place prevents weak suspensory ligaments from causing any issues. Sometimes the old dislocated lens may be able to be repositioned to be sewn in place; sometimes the previous lens may need to be removed beforehand and a new lens placed.
But even if a new lens can’t be sewn into place, a new lens may be able to be placed in the space in the front of the eye above the iris (called the anterior chamber).
Either way, often there is a solution to fix the dislocated lens.
Summary
Nobody is ever totally free and clear from having their lens dislocate after cataract surgery. It can happen at any time following the procedure. Fortunately, it is rare and certain individuals are going to be at a much greater risk than others. If it does happen, very likely you will have a sudden change in vision with the potential for double vision.
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