Posterior Capsule Rupture Linked to Higher IOL Dislocation Risk

A dislocated intraocular lens (IOL) occurs when an artificial lens shifts, tilts or falls out of place after cataract surgery, causing symptoms like sudden blurred/double vision, glare or seeing the edge of the lens. Photo: Xu S, et al. PLoS One. June 25, 2025. Click image to enlarge. In a recent Clinical Ophthalmology study, researchers reported that posterior capsule rupture during cataract surgery significantly raises the risk of patients with intraocular lens (IOL)  dislocation and need for surgical repair.Examining data from a large clinical database that covered 176,572 eyes after planned phacoemulsification cataract surgery, the researchers reviewed records collected over 12 years from multiple centers that used the same electronic medical record system. They mentioned in their paper that they excluded “eyes that underwent planned large-incision cataract surgery, were left aphakic during initial surgery and those that underwent retina or other intraocular surgery between initial cataract surgery and development of IOL dislocation.” This left 176,427 eyes that “did not develop IOL dislocation” and 145 that did develop it, requiring a second surgery for IOL.The study population included adults between the ages of 18 and 80 who were divided into groups of 18 to 40, 40 to 60, 60 to 80, and those over 80 years old. The majority of patients (57.1%) fell into the group aged 60 years or older, although the authors noted that it was younger patients who showed a higher IOL risk. Men made up a larger share (54.5%) of dislocation cases than women. Diabetes affected about 17% of all eyes but did not raise dislocation risk. Other eye conditions found in the medical records included glaucoma in about 8% of patients, pseudoexfoliation in about 1% and pathological myopia in about 3%.Throughout the study, surgeons recorded every intraoperative event that patients underwent, including pupil expansion devices, iris damage, use of capsular tension rings, zonular dialysis and combined procedures.The researchers wrote in their paper that “among the eyes with IOL dislocation, the average time to surgery was 408.6 days, and the median time to surgery was 49 days.” They also noted that 63.4% of eyes received IOL surgery “within 90 days of the initial cataract surgery” and 36.6% received it after more than 90 days. The analysis showed that age between 18 and 40 years raised risk 4.5-fold while age 40 to 60 years raised it 2.6-fold. Male sex increased risk 1.5-fold. Pseudoexfoliation, zonular dialysis, iris damage and combined phacoemulsification with vitrectomy were also contributors to a greater risk. Factors that did not raise risk included white or brunescent cataracts, small pupil size, diabetic retinopathy, glaucoma or prior trabeculectomy.The authors concluded that doctors can use these findings for better preoperative planning and to choose support devices in high-risk eyes.Click here for the journal source. Karimaghaei S, Shakarchi AF, Shakarchi FF, et al. Risk factors for intraocular lens dislocation requiring surgical intervention after initial phacoemulsification cataract surgery. Clin Ophthalmol. April 14, 2026. [Epub ahead of print]. This article was developed by the editorial staff in conjunction with experts in the field. In the process, AI may have been among the editorial tools used to meet the goals of human editors, who approved all content.