Clinical Ophthalmology (Mar 2023)

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

  • Patel V,
  • Pakravan P,
  • Lai J,
  • Watane A,
  • Mehra D,
  • Eatz TA,
  • Patel N,
  • Yannuzzi NA,
  • Sridhar J

Journal volume & issue
Vol. Volume 17
pp. 941 – 951

Abstract

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Veshesh Patel,1 Parastou Pakravan,1 James Lai,1 Arjun Watane,1,2 Divy Mehra,1 Tiffany Alyssa Eatz,1 Nimesh Patel,1,3 Nicolas A Yannuzzi,1 Jayanth Sridhar1 1Bascom Palmer Eye Institute at the University of Miami Miller School of Medicine, Miami, FL, USA; 2Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, CT, USA; 3Mass, Eye and Ear, Harvard Medical School, Boston, MA, USACorrespondence: Jayanth Sridhar, Bascom Palmer Eye Institute at the University of Miami Miller School of Medicine, 900 NW 17th Street, Miami, FL, 33136, USA, Tel +1 305-326-6124, Fax +1 305-326-6417, Email [email protected]: 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

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