Lens capsular accumulation of advanced glycation end products in eyes with intraocular lens dislocation

Purpose: Late in-the-bag intraocular lens (IOL) dislocation after cataract surgery has been associated with degenerative changes of the lens capsule, but the relationship between capsular degeneration and accumulation of advanced glycation end products (AGEs) remains unclear. We compared AGE accumulation in anterior lens capsules from eyes with IOL dislocation and cataract controls to clarify its clinicopathological significance. Methods: This single-centre retrospective observational study included 11 eyes that underwent surgery for IOL dislocation (6 dead bag syndrome [DBS], 5 capsular bag dislocation [CBD]) and 11 eyes that underwent routine cataract surgery between 2022 and 2025. AGE immunofluorescence of excised anterior capsules was quantified as the AGE-positive area (µm²). AGE-positive areas were compared between the IOL dislocation and cataract groups and between DBS and CBD. Results: Patients with IOL dislocation were younger than cataract controls (53.1 ± 11.3 vs. 70.1 ± 12.1 years, p = 0.007). The AGE-positive area of the lens capsule was significantly higher in the IOL dislocation group than in the cataract group (59.7 ± 21.0 µm² vs. 33.3 ± 23.9 µm², p = 0.010). Within the IOL dislocation group, DBS showed greater AGE accumulation than CBD (71.6 ± 17.3 µm² vs. 45.5 ± 16.4 µm², p = 0.030). In all specimens, AGE staining was detected on the anterior-chamber side of the capsule and in residual lens epithelial cells. Conclusions: Eyes with IOL dislocation, particularly DBS, exhibited marked accumulation of AGEs in the anterior lens capsule. These findings suggest that AGE accumulation is associated with degenerative changes of the lens capsule and may contribute to superficial capsular peeling and deep intralamellar splitting in late in-the-bag IOL dislocation.