Capsular Bag Preservation for Fixation of Late Intraocular Lens Dislocations

Purpose: To determine whether preservation of the intact capsular bag allows safe iris fixation of a single‑piece acrylic intraocular lens (IOL) in cases of late, in‑the‑bag dislocation. Methods: We retrospectively reviewed 182 eyes from 172 patients who underwent fixation of dislocated IOL by a single retina surgeon between January 2018 and September 2024. Only eyes with ≥6 months of follow-up were included (140 eyes, 132 patients). Charts were reviewed for demographics, IOL type, capsular bag integrity, and etiology of dislocation. Main outcomes were postoperative ocular hypertension, uveitis, hyphema, vitreous hemorrhage, cystoid macular edema, retinal detachment, re-dislocation, and corneal edema at ≥6 weeks, ≥3 months, and ≥12 months. Results: Of 140 eyes, 80 (57%) had late dislocation of a single‑piece acrylic IOL within an intact capsular bag, and 60 (43%) had dislocation of a 3-piece IOL without an intact capsule. Postoperative complication rates did not differ significantly between single‑piece acrylic in-the-bag and 3-piece out-of-the-bag groups at ≥6 weeks ( P = .71), ≥3 months ( P = .84), or ≥12 months ( P = .18). Conclusions: Preservation of an intact capsular bag allows refixation of a single‑piece acrylic IOL with a complication profile comparable to iris fixation of a 3-piece IOL lacking capsular support. This supports capsular bag preservation as a viable alternative to IOL explantation in late, in-the-bag dislocations.