Explantation of intraocular lenses

Abstract

Cataract surgery has evolved recently along with the development of intraocular lenses. With this evolution of intraocular lenses from anterior chamber and iris-fixated lenses to more modern foldable posterior intraocular lenses has come an evolution in the complications that necessitate removal of the intraocular lens. Early generations of anterior chamber and iris-fixated intraocular lenses often had severe complications associated with them, such as pseudophakic bullous keratopathy, uveitis-glaucoma-hyphema syndrome, and chronic cystoid macular edema. With modern foldable intraocular lenses, decentration-dislocation and incorrect lens power, and glare and optical aberrations are leading indications for explantation. Some complications appear to be unique to particular styles of modern intraocular lenses, with incidence of glare and optical aberrations increasing, especially in acrylic and multifocal intraocular lenses. The clinical outcomes after an intraocular lens explantation or exchange have also improved markedly with the advent of modern foldable intraocular lenses. Postoperative visual acuity results are dependent on the preoperative complications associated with the explanted intraocular lens. Final visual results after exchange of modern foldable intraocular lenses have been uniformly good. This is probably because of fewer severe complications that lead to explantation of the intraocular lens.

Limbal relaxing incisions at the time of apodized diffractive multifocal intraocular lens implantation to reduce astigmatism with or without subsequent laser in situ keratomileusis

“…In addition, because multifocal IOLs split the available light, eyes with these IOLs may be more sensitive to residual cylindrical refractive errors. 8,9 This uncorrected astigmatism may lead to spectacle use and patient dissatisfaction postoperatively.…”

“…Although most cases were mild, temporary, and improved with artificial tear and cyclosporine treatment, in 2 eyes with moderate to severe dry eye the CDVA decreased 1 line over the 1-month level. Because multifocal IOLs split the light and are more sensitive to changes in contrast sensitivity, 1,9,24 it is possible that effects of dry eye on visual quality is potentiated by multifocal IOL implantation (E. Donnenfeld, MD, et al, ''Efficacy of Topical Cyclosporine Versus Tears for Improving Visual Outcomes Following Multifocal IOL Implantation,'' presented at the ASCRS Symposium on Cataract, IOL and Refractive Surgery, San Diego, California, USA, April 2006). 25 The rate of dry eye was also high after LASIK enhancement.…”

“…In addition, because multifocal IOLs split the available light, eyes with these IOLs may be more sensitive to residual cylindrical refractive errors. 8,9 This uncorrected astigmatism may lead to spectacle use and patient dissatisfaction postoperatively.One way to correct astigmatism after cataract surgery is to treat preexisting cylinder by creating limbal relaxing incisions (LRIs) at the time of IOL implantation. 10 This obviates the need for a second surgery.…”

Stability and safety of MA50 intraocular lens placed in the sulcus

“…8 When sulcus foldable acrylic IOLs were studied in the pediatric population, lens decentration was found to be present in~5% of eyes. 9,10 In one study, 3 of 55 eyes had decentration, none of which needed surgery or were considered visually significant.…”

Iritis mit Entgleisung des Intraokulardrucks bei Dislokation der Hinterkammerlinse

“…Trotz unterschiedlicher Therapieansätze konnte letztlich nur die Reposition bzw. Explantation der verursachenden IOL als erfolgreiche Therapie festgestellt werden [2,3,5,6].…”