Feasibility of multifocal intra‐ocular lens exchange and conversion to the bag‐in‐the‐lens implantation

Abstract

. Purpose: Our purpose was to evaluate the surgical outcome after intra‐ocular lens exchange in patients who presented impairing visual complaints after primary multifocal intra‐ocular lens (MIOL) implantation. In particular, the study was undertaken to look at the number of eyes that could be equipped with the bag‐in‐the‐lens (BIL) IOL after MIOL exchange. Methods: This series consisted of 30 eyes of 21 consecutive patients scheduled for MIOL exchange. In 15 out of the 30 eyes, IOL misalignment was measured on slit lamp anterior segment photo’s after defining the mathematical centres of the IOL optic, pupil and limbus. Results: Diffractive MIOL was more frequently explanted (25; 83%) when compared with refractive MIOL (4; 13%) and progressive optic IOL (1; 4%). In 21 out of the 30 eyes (70%) a bag‐in‐the‐lens could be implanted. In 7 out of the 30 eyes (23%), the capsule was not considered sufficiently stable to accommodate an IOL. An iris‐fixated IOL or a sulcus‐fixated IOL was then implanted. In 2 out of the 30 eyes (6%) the remaining capsular bag could accommodate a traditional lens‐in‐the‐bag only. Eyes that underwent Nd:YAG laser capsulotomy prior to the MIOL exchange needed anterior vitrectomy peroperatively (11 eyes; 37%). Visual acuity improved postoperatively in 13 out of the 30 eyes and remained stable in 17 out of the 30 eyes. Conclusions: Since the BIL technique requires a very well‐preserved capsular bag for the purpose of the IOL implantation, the success rate of BIL implantation after MIOL is a good indicator to evaluate the degree of difficulty to exchange MIOL.

Visual outcomes in eyes with a distance-dominant diffractive multifocal intraocular lens with low near addition power

“…Second, the halo and glare symptoms are more extensive with multifocal IOLs than with monofocal IOLs 5 – 7. A certain percentage of patients experience the serious adverse effects of multifocal IOLs and wish to undergo an exchange to the monofocal IOLs 8 – 10. Although the contrast sensitivity loss and degree of photic phenomena are ameliorated by a diffractive multifocal IOL with +3 D addition, adverse effects remain 4 13 14.…”

Retreatments after multifocal intraocular lens implantation: an analysis

“… 3 , 7 Contrast sensitivity complaints, glare, and halos have also been commonly reported in multiple studies. 2 , 4 , 11 These phenomena are usually attributed to the fact that multifocal IOL designs split incoming light to provide simultaneous correction of distance and near vision. 4 , 12 In the majority of patients, symptoms either improve with time 13 , 14 or can be treated successfully.…”

The importance of angle kappa evaluation for implantation of diffractive multifocal intra‐ocular lenses using pseudophakic eye model

“…Unfortunately, in some cases, even an IOL exchange is required (Woodward et al 2009). However, the bag-in-the-lens could only be implanted in 70% of the eyes (Tassignon et al 2014). A lot of studies have focused directly on the analysis of the governing factors for patient satisfaction or dissatisfaction after MIOL implantation and attempted to find criteria for patient selection (Walkow & Klemen 2001;Blaylock et al 2008;Kohnen et al 2008;Pepose 2008;Woodward et al 2009;De Vries et al 2011).…”