Abstract
Purpose :
Currently, the method of intraocular lens (IOL) exchange and choice of lens currently largely rests on surgeon preferences. The purpose of the current study was to analyze the indications, outcomes, and complications of IOL exchanges among a variety of techniques and IOL models at a tertiary ophthalmic referral center.
Methods :
Patients at Bascom Palmer Eye Institute that underwent IOL exchange recorded between May 1, 2014 to August 31, 2020 were included. Demographic, clinical, and surgical data were collected, as well as information regarding the IOLs employed.
Results :
IOL exchange was identified in 513 eyes of 490 patients. The mean best corrected visual acuity (BCVA) in logarithm of the minimum angle of resolution (logMAR) prior to IOL exchange was 0.695 ± 0.685 (Snellen: 20/99). The most common precipitating reasons for exchange were IOL dislocation (n=285, 46.6%), subluxation (n=52, 8.5%), uveitis-glaucoma-hyphema (UGH) (n=35, 5.7%), broken haptic (n=22, 3.6%), refraction error (n=20, 3.3%), and corneal edema (n=18, 3.0%). The most common lenses used for IOL exchange were Alcon MA60AC (n=116, 22.6%), Alcon MTA3/4/5UO (n=113, 22.0%), Akreos AO60 (n=88, 17.2%), ABBOTT Tecnis PCB00 (n=37, 7.2%), and Alcon MA50BM (n=37, 7.2%). The most frequent complications following IOL exchange were cystoid macular edema (n=38, 11.2%), corneal edema (n=36, 10.1%), elevated intraocular pressure (n=27, 7.9%), and epiretinal membrane (n=22, 6.5%). 14 out of the 21 reoperations following IOL exchange were indicated for a repeat exchange, most commonly due to dislocation (n=9, 64.3%), vitreous hemorrhage (n=3, 21.4%), UGH (n=1, 7.1%), subluxation (n=1, 7.1%), corneal edema (n=1, 7.1%), ruptured globe (n=1, 7.1%), dysphotopsia (n=1, 7.1%), and Weill-Marchesani syndrome (n=1, 7.1%).
Conclusions :
In conclusion, lens dislocations were the most common indications for IOL exchange. Certain lens models were also associated with complications, including Akreos AO60 with corneal edema, Alcon MTA3/4/5UO and Akreos AO60 with cystoid macular edema, and ABBOTT Tecnis PCB00 with posterior chamber opacification. While the these complications may also be explained by a patient's ocular history, surgeons may use these findings to guide IOL selection in the setting of IOL exchange.
This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.