IOL dislocation drives most explants

An intraocular lens is supposed to sit quietly in the capsular bag for years. When it shifts, tilts, or drops out of position, vision can get weird fast — glare, monocular double vision, refractive surprise, sometimes a lens that is functionally no longer doing its job. The new thing here is not a sudden spike. It is the stubbornness of the pattern. A 2025 ARVO abstract updating the ASCRS/ESCRS annual explant survey said dislocation and decentration were still the leading reasons surgeons removed or secondarily intervened on foldable IOLs, based on 2023 cases. (iovs.arvojournals.org) ### What is this survey actually tracking? This is a long-running surgeon survey on foldable IOLs that needed explantation or some secondary intervention. The 2025 update covered the 2023 calendar year, collected through ASCRS and ESCRS channels, and added 111 completed case reports to a running total of 1,738 surveys from 2007 through 2023. (iovs.arvojournals.org) ### Why does dislocation keep topping the list? Because a lot of explants are really support-system failures. The lens may be fine, but the bag, zonules, or fixation are not. The ARVO update says dislocation or decentration remained the most common complication overall and the leading cause of explantation in most IOL ty(iovs.arvojournals.org)attern for years. (iovs.arvojournals.org) ### What does “dislocation” mean here? It ranges from a mild decentration all the way to a lens that has shifted badly enough to threaten vision or require retrieval. The AAO puts clinically significant IOL dislocation in the uncommon-but-real category, with reported incidence around 0.2% to 3.0%. Early cases tend to ref(iovs.arvojournals.org)ort structures slowly give way. (iovs.arvojournals.org) ### Which eyes are most at risk? The repeat offenders are eyes with weak zonules or compromised capsular support. Pseudoexfoliation, prior vitrectomy or vitreoretinal surgery, trauma, and high myopia keep showing up across the survey coverage and clinical reviews. AAO’s review also flags connective-tissue disorders, caps(iovs.arvojournals.org) only as stable as the scaffold holding it. (ophthalmologytimes.com) ### Is this only about monofocal lenses? No — but the failure modes differ by lens category. The 2025 update says glare and optical aberrations remained a common complication for multifocal IOLs across the 17-year trend, while dislocation or decentration dominated overall and in(ophthalmologytimes.com)licone lenses in specific settings. (iovs.arvojournals.org) ### So what should surgeons do with this? The practical message is preop screening and intraop respect for support structures. If the eye has signs of zonular weakness, prior posterior-segment surgery, trauma history, or pseudoexfoliation, the fixation plan matters more from the start. AAO’s guidance stresses checking ca(iovs.arvojournals.org) may be needed if the lens is significantly posteriorly displaced. (aao.org) ### Why does this matter beyond a niche cataract-surgery issue? Because cataract surgery is so common that even uncommon complications add up. And explant surgery is not a trivial redo — it is a more complex operation layered on top of a prior one. The survey’s persistence tells you something important: surgeons have gotten better(aao.org)is still the thing that can come back years later. (ophthalmologytimes.com) ### Bottom line? The headline is simple. When IOLs need to come out, the usual culprit is still that the lens no longer sits where it should. That pushes the focus upstream — find weak zonules early, preserve support during surgery, and choose a fixation strategy that matches the eye in front of you. (iovs.arvojournals.org)