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

Veshesh Patel; Parastou Pakravan; James Lai; Arjun Watane; Divy Mehra; Tiffany Alyssa Eatz; Nimesh Patel; Nicolas A Yannuzzi; Jayanth Sridhar

doi:10.2147/OPTH.S399857

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

Clin Ophthalmol. 2023 Mar 23:17:941-951. doi: 10.2147/OPTH.S399857. eCollection 2023.

Authors

Affiliations

¹ Bascom Palmer Eye Institute at the University of Miami Miller School of Medicine, Miami, FL, USA.
² Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, CT, USA.
³ Mass, Eye and Ear, Harvard Medical School, Boston, MA, USA.

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: Yamane; cataracts; complications; dislocation; intraocular lens; techniques.

Grants and 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.