Abstract
Purpose :
To identify the incidence, indications, risk factors and visual outcomes of intraocular lens (IOL) explantation/exchange associated with cataract surgery.
Methods :
Retrospective study of IOL explantation/exchange at a tertiary centre (Riyadh, KSA: 2010-2016). Patients and controls were identified based on diagnostic coding. First all surgeries coded as "phacoemulsification with IOL" were identified, and subsequently all those coded as "replacement/removal of artificial lens" were identified. The two files were then matched, and the surgeries included in both files were defined as patients. For these, pre-operative clinical characteristics, indications, types of IOL explanted, complications, and visual outcomes were determined. The control arm consisted of an equal number of age-matched controls that had cataract surgery alone, without IOL explantation, at the same centre during the same time period.
Results :
Among the total number of phacoemulsification with IOL surgeries (n≥17415 eyes) done during the period, 48 eyes of 46 patients who had IOL exchange/removal were identified. This corresponds to an incidence of IOL removal/exchange of 28 per 10,000 surgeries. The most common ocular comorbidity was high axial length (25.0%, p=<0.001). Diabetes was present in 25% of patients and 31% of controls. The most frequent intraoperative adverse events were posterior capsular tears (27.1% vs 8.3% in controls) and subluxated IOL (6.3% vs 0 in controls). The most frequent indications for IOL removal/exchange were high residual refractive error (21%), in the bag subluxation (19%), out of the bag subluxation (15%), and chronic uveitis (10%). In both patients and controls, initial IOL position was most frequently in the bag (58.3% and 89.6% respectively), sulcus (20.8% and 6.3% respectively), or anterior chamber (16.7% and 0% respectively). The final location of re-implanted IOL was most frequently in the bag (37.5%), sulcus (22.9%), scleral fixated (12.5%) or iris fixated (10.4%). Aphakia was present in 6%. The final visual acuity was 20/20 to 20/60 in 60.4% of patients compared to 83.3% of controls, and <20/60 to 20/200 in 25.0% of patients compared to 12.5% of controls (p=0.02).
Conclusions :
IOL explant/exchange is rare yet affects the final visual outcome adversely. The most frequent indication was high residual refractive error. High axial length is a significant risk factor.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.