Late Spontaneous in-the-Bag Capsular Tension Ring - Intraocular Lens - Capsular Bag Complex Subluxation in a Low-PEX Region: A Series of 31 Cases.

Purpose: To evaluate the incidence, risk factors, and surgical management of CTR-IOL-CB complex subluxation/dislocation in a low-pseudoexfoliation area. Methods: Patients with CTR-IOL-CB complex subluxation/dislocation who had complete medical records at the Qingdao Eye Hospital of Shandong First Medical University between January 1994 and April 2024 were selected. Patient demographic data, incidence, interval, risk factors, extent of zonular weakness, IOL and CTR design and material, surgical management, visual acuity (VA), and other complications. Results: 31 cases aged 65.17 ± 7.19 years at CTR-IOL-CB complex subluxation/dislocation were reviewed; the interval was 41.23 ± 14.63 months after implantation of IOL and CTR. The incidence rate of CTR-IOL-CB complex subluxation/dislocation was 0.85%. The most common risk factors were ocular trauma and hypermature cataract. Extent of zonular weakness of ≥4 o'clock and the use of 1-piece hydrophilic acrylic and 3-piece hydrophobic acrylic IOLs were susceptible to complex subluxation/dislocation. VA was significantly increased after IOL repositioning or exchange; no other complications were present. Conclusion: Zonular insufficiency stabilized with IOL and CTR alone still carries a risk of re-dislocation. Ocular trauma and hypermature cataract were the most common risks in a low-pseudoexfoliation region. IOL exchange or repositioning is effective for this complication.