Intraocular lens explantation or exchange: indications, postoperative interventions, and outcomes

Abstract

Cataracts are one of the most common eye diseases associated with blindness (visual acuity worse than 20/400 in the better eye with best correction) worldwide, with an estimated 18 million people thought to be affected, and cataract surgery is the intraocular procedure performed most often worldwide. Over the years, the techniques of cataract surgery have evolved into a safe and successful procedure for visual rehabilitation. The incidence of most complications has significantly decreased with the development of better instrumentation and affordable, high-quality intraocular lens (IOL) implants (1) . Various aspects of cataract surgery that make it safer have changed ABSTRACT Purpose: To analyze the indications for explantation or exchange of intraocular lenses (IOLs), which were originally implanted for the correction of aphakia during cataract extraction. Methods: All cases that involved intraocular lens explantation or exchange in one institution between January 2008 and December 2014 were analyzed re tros pectively. Results: In total, 93 eyes of 93 patients were analyzed. The median time interval between implantation and explantation of the anterior chamber intraocular lenses (AC IOL) and posterior chamber intraocular lenses (PC IOL) was 83.40 ± 83.14 months (range: 1-276 months) and 55.14 ± 39.25 months (range: 1-168 months), respectively. Pseudophakic bullous keratopathy (17 eyes, 38.6%) and persistent iritis (12 eyes, 27.8%) in the AC IOL group and dislocation or decentration (30 eyes, 61.2%) and incorrect IOL power (nine eyes, 18.4%) in the PC IOL group were the most common indications for explantation of IOLs. The mean logMAR best corrected visual acuity (BCVA) improved significantly from 1.30 preoperatively to 0.62 postoperatively in the PC IOL group (p<0.001) but did not improve significantly in the AC IOL group (p=0.186). Conclusions:The primary indication for IOL explantation or exchange was pseudophakic bullous keratopathy in the AC IOL group and was dislocation or decentration in the PC IOL group. PC IOL explantation or exchange is safe and im proves visual acuity.

Optic replacement in a novel modular intraocular lens system

“…Incorrect lens power, patient dissatisfaction, and IOL opacification are common reasons for IOL replacement . Despite advances in biometry and IOL calculations, Behndig et al showed in a large analysis of Swedish cataract surgical outcomes that only two thirds of eyes planned for emmetropia become emmetropic .…”

“…Incorrect lens power, patient dissatisfaction, and IOL opacification are common reasons for IOL replacement. [1][2][3][4][5][6][7]9,10 Despite advances in biometry and IOL calculations, Behndig et al showed in a large analysis of Swedish cataract surgical outcomes that only two thirds of eyes planned for emmetropia become emmetropic. 13 While there are several options to correct residual refractive error after cataract surgery, including laser in situ keratomileusis, photorefractive keratectomy, piggyback IOLs and light-adjustable lenses, limitations and drawbacks exist for each technique.…”

“…Almost 1% of cataract surgery patients will eventually require an intraocular lens (IOL) exchange . While IOL dislocation/decentration is the most common reason for IOL exchange, ranging between 37.3% and 46% of the cases, incorrect IOL power (23–41.2%), IOL opacification (7%) and patient dissatisfaction (21%) are other common causes . Furthermore, patient expectations are increasingly high, especially with increased use of premium IOLs .…”

“…1,2 While IOL dislocation/decentration is the most common reason for IOL exchange, ranging between 37.3% and 46% of the cases, incorrect IOL power (23-41.2%), IOL opacification (7%) and patient dissatisfaction (21%) are other common causes. 1,[3][4][5][6][7] Furthermore, patient expectations are increasingly high, especially with increased use of premium IOLs. 8 Patient dissatisfaction unique to these lenses may include causes such as waxy vision, decreased contrast sensitivity and photic phenomena for multifocal IOLs, which may lead to IOL exchanges.…”

Intraocular Lens Dislocation into the Anterior Chamber because of Repeated Eye-Poking in a Patient with Leber’s Congenital Amaurosis

“…A study was conducted in 2015 to review the most common indications for AC explantation. Pseudophakic bullous keratopathy was the most common indication, accounting for 38.6% of the cases, followed by persistent iritis (27.8%), IOL decentration (13.6%), glaucoma (11.4%), refractive error (2.3%), and glare (2.3%) [9].…”