Intraocular lens exchange or explantation post cataract surgery
Author:
Corresponding Author:

Arundhati Dvivedi. Department of Cataract, LV Prasad Eye Institute, LV Prasad Marg, Banjara Hills, Hyderabad 500034, Telangana, India. arundhati.dvivedi@lvpei.org

  • Article
  • | |
  • Metrics
  • |
  • Reference [23]
  • |
  • Related
  • |
  • Cited by
  • | |
  • Comments
    Abstract:

    AIM: To report incidence, indications, and visual outcomes of intraocular lens (IOL) exchange/explantation surgery. METHODS: Retrospective analysis of 60 eyes requiring IOL exchange/explantation surgery between 1st January 2017 and 31st December 2022. The overall outcomes as well as comparison between the trainee versus experienced surgeons were analyzed. RESULTS: Out of 39 778 cataract surgeries (with no preexisting ocular co-morbidities) during a six-year period (2017–2022), 60 (0.15%) needed IOL exchange/explantation. Surgeons-under-training performed 36/60 cases (60%) while 24/60 (40%) were by experienced surgeons. The commonest indication was subluxated IOL in 26 (43.3%), followed by dislocated IOL in 20 (33.3%), postoperative refractive surprise in 7 (11.6%), IOL induced uveitis in five and broken haptic in two eyes. Twenty-four (40%) eyes had intraoperative complications during primary surgery. Posterior chamber IOL (PCIOL) was the commonest secondary IOL in 21 (35%) eyes, scleral fixated in 20 (31.6%), anterior chamber IOL (ACIOL) in 13 (21.6%), iris fixated IOL in three (5%) and three eyes (5%) were left aphakic. The mean time between primary and secondary surgery was 168d (168±338.8). Best corrected visual acuity (BCVA) of >20/60 was obtained in 43 eyes (71.66%), 20/80–20/200 in 14 (23.33%), 20/250 in two and hand movements in one. No statistically significant difference in visual outcome was noted at post-op one month between trainees versus experienced surgeons (UCVA 0.45±0.29 vs 0.53±0.32, P=0.20, BCVA 0.34±0.25 vs 0.37±0.26, P=0.69). CONCLUSION: IOL subluxation as the commonest indication and posterior capsular rupture is the commonest intraoperative risk factor. This complication can be effectively addressed with selection of the appropriate secondary IOL achieving good visual outcomes in over 70% of patients.

    Reference
    1 Patel V, Pakravan P, Lai J, Watane A, Mehra D, Eatz TA, Patel N, Yannuzzi NA, Sridhar J. Intraocular lens exchange: indications, comparative outcomes by technique, and complications. Clin Ophthalmol 2023;17:941-951.
    2 Hahn U, Krummenauer F, Kölbl B, et al. Determination of valid benchmarks for outcome indicators in cataract surgery: a multicenter, prospective cohort trial. Ophthalmology 2011;118(11):2105-2112.
    3 Jin GJ, Crandall AS, Jones JJ. Changing indications for and improving outcomes of intraocular lens exchange. Am J Ophthalmol 2005;140(4):688-694.
    4 Leysen I, Bartholomeeusen E, Coeckelbergh T, Tassignon MJ. Surgical outcomes of intraocular lens exchange: five-year study. J Cataract Refract Surg 2009;35(6):1013-1018.
    5 Jones JJ, Jones YJ, Jin GJ. Indications and outcomes of intraocular lens exchange during a recent 5-year period. Am J Ophthalmol 2014;157(1):154-162.e1.
    6 Chakrabarti A, Nazm N. Posterior capsular rent: prevention and management. Indian J Ophthalmol 2017;65(12):1359-1369.
    7 Jeang LJ, Liechty JJ, Powell A, Schwartz C, DiSclafani M, Drucker MD, McDowell WM. Rate of posterior capsule rupture in phacoemulsification cataract surgery by residents with institution of a wet laboratory course. J Acad Ophthalmol 2022;14(1):e70-e73.
    8 Jacobsen MF, Holm LM, Erichsen JH, Konge L, Siersma V, la Cour M, Thomsen ASS. Defining the surgical footprint in cataract surgery: patient-related outcomes dependent on the experience of the surgeon. Acta Ophthalmol 2021;99(7):e999-e1005.
    9 Gimbel HV, Condon GP, Kohnen T, Olson RJ, Halkiadakis I. Late in-the-bag intraocular lens dislocation: incidence, prevention, and management. J Cataract Refract Surg 2005;31(11):2193-2204.
    10 Baykara M, Ozcetin H, Yilmaz S, Timuçin OB. Posterior iris fixation of the iris-claw intraocular lens implantation through a scleral tunnel incision. Am J Ophthalmol 2007;144(4):586-591.
    11 Por YM, Lavin MJ. Techniques of intraocular lens suspension in the absence of capsular/zonular support. Surv Ophthalmol 2005;50(5): 429-462.
    12 Agarwal A, Kumar DA, Jacob S, Baid C, Agarwal A, Srinivasan S. Fibrin glue-assisted sutureless posterior chamber intraocular lens implantation in eyes with deficient posterior capsules. J Cataract Refract Surg 2008;34(9):1433-1438.
    13 Limburg H, Foster A, Gilbert C, Johnson GJ, Kyndt M, Myatt M. Routine monitoring of visual outcome of cataract surgery. part 2:results from eight study centres. Br J Ophthalmol 2005;89(1):50-52.
    14 Jakobsson G, Zetterberg M, Lundström M, Stenevi U, Grenmark R, Sundelin K. Late dislocation of in-the-bag and out-of-the bag intraocular lenses: ocular and surgical characteristics and time to lens repositioning. J Cataract Refract Surg 2010;36(10):1637-1644.
    15 Mönestam EI. Incidence of dislocation of intraocular lenses and pseudophakodonesis 10 years after cataract surgery. Ophthalmology 2009;116(12):2315-2320.
    16 Dabrowska-Kloda K, Kloda T, Boudiaf S, Jakobsson G, Stenevi U. Incidence and risk factors of late in-the-bag intraocular lens dislocation: evaluation of 140 eyes between 1992 and 2012. J Cataract Refract Surg 2015;41(7):1376-1382.
    17 Jafarinasab M, Kalantarion M, Hooshmandi S, Hassanpour K, Najdi D, Kheiri B, Sabbaghi H. Indications and outcomes of intraocular lens exchange among pseudophakic eyes in a Tertiary Referral Center. BMC Ophthalmol 2023;23(1):127.
    18 Davies EC, Pineda R 2nd. Intraocular lens exchange surgery at a tertiary referral center: indications, complications, and visual outcomes. J Cataract Refract Surg 2016;42(9):1262-1267.
    19 Chan TC, Lok JK, Jhanji V, Wong VW. Intraocular lens explantation in Chinese patients: different patterns and different responses. Int Ophthalmol 2015;35(5):679-684.
    20 Mamalis N, Davis B, Nilson CD, Hickman MS, Leboyer RM. Complications of foldable intraocular lenses requiring explantation or secondary intervention—2003 survey update. J Cataract Refract Surg 2004;30(10):2209-2218.
    21 Elhusseiny AM, Lee RK, Smiddy WE. Surgical management of uveitis-glaucoma-hyphema syndrome. Int J Ophthalmol 2020;13(6):935-940.
    22 Thevi T, Abas AL. Vitreous loss-causes, associations, and outcomes: eight-year analysis in melaka hospital. Oman J Ophthalmol 2018;11(2):113-118.
    23 Lee MH, Webster DL. Intraocular lens exchange-removing the optic intact. Int J Ophthalmol 2016;9(6):925-928.
    Related
    Cited by
Get Citation

Arundhati Dvivedi, Somasheila I Murthy, Sukesh Manga. ,/et al.Intraocular lens exchange or explantation post cataract surgery. Int J Ophthalmol, 2024,17(11):2031-2036

Copy
Share
Article Metrics
  • Abstract:
  • PDF:
  • HTML:
  • Cited by:
Publication History
  • Received:April 04,2024
  • Revised:June 26,2024
  • Online: October 23,2024