Intraocular Lens Exchange: Indications, Comparative Outcomes by Technique, and Complications

Abstract

Purpose

To describe the indications, outcomes, and complications associated with intraocular lens (IOL) exchange.

Patients and Methods

To determine the relative frequency of postoperative complications between techniques for all patients undergoing IOL exchange from May 1, 2014 through August 31, 2020.

Results

IOL exchange was performed in 511 eyes of 489 patients (59.7% men; mean age: 67.0 ± 13.9 years, median time from cataract procedure to IOL exchange: 47.5 months). Mean uncorrected visual acuity significantly improved from 20/192 Snellen equivalent (logMAR 0.981) preoperatively to 20/61 (logMAR 0.487) at last follow-up (P < 0.001). Overall, 384 eyes (78.7%) met their desired refractive outcome within ±1.0 diopter (D). The most frequent complication was cystoid macular edema (CME) (n=39, 7.6%). Iris-sutured technique was associated with significantly greater frequency of subsequent IOL dislocation (10.3%) than 4-point scleral sutured (0%, P = 0.002), anterior chamber IOL (ACIOL, 1.5%, P = 0.01), and 2-point scleral sutured (0%, P = 0.03) techniques. Yamane scleral-fixation technique was associated with significantly greater frequency of developing IOL tilt (11.8%) than ACIOL (0%, P = 0.002), 4-point scleral sutured (1.1%, P = 0.01), 2-point scleral sutured (0%, P = 0.04), and iris-sutured (0%, P = 0.04) techniques.

Conclusion

IOL exchange significantly improved uncorrected visual acuity and more than three-quarters of eyes met the refractive goal. Certain techniques were associated with complications, including subsequent dislocation associated with iris-sutured technique and IOL tilt associated with Yamane scleral-fixation technique. This information may help guide surgeons in deciding between procedural techniques for individual patients during IOL exchange preoperative planning.

Keywords:

• intraocular lens
• dislocation
• Yamane
• techniques
• cataracts
• complications

Acknowledgments

This paper was presented at the Association for Research in Vision and Ophthalmology and Southern Medical Association as an abstract presentation with interim and preliminary findings. The poster’s abstract was published in “Poster Abstracts” in Investigative Ophthalmology & Visual Science June 2022, Vol. 63, 1803: https://iovs.arvojournals.org/article.aspx?articleid=2782331 and https://sma.org/abstracts/intraocular-len-exchange/

Disclosure

Dr Patel is a consultant for Alimera Sciences, Allergan, Alcon, Eye Point, Genentech, and Novartis. Dr Yannuzzi is a consultant for Alimera Sciences, Genentech, REGENXBIO, and Novartis. Dr Sridhar is a consultant for Alcon, Apellis, Allergan, Dorc, Genentech, Regeneron, and Ocuterra. The authors report no other conflicts of interest in this work.

Additional information

Funding

Bascom Palmer Eye Institute received funding from the NIH Core Grant P30EY014801, Department of Defense Grant #W81XWH-13-1-0048, and a Research to Prevent Blindness Unrestricted Grant. The sponsors or funding organizations had no role in the design or conduct of this research.