Abstract | April 6, 2022

A 6-Year Retrospective Study of Intraocular Len Exchange

Presenting Author: Veshesh Patel, Bachelor of Science (BS), Medical Student, 3rd Year, Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Davie, Florida

Coauthors: James Lai, BS, Medical Student 1st Year, MD, Miami Miller School of Medicine, Miami, FL; Arjun Watane, MD, Ophthalmology, Intern, Yale University, New Haven, Connecticut; Divy Mehra, BS, Medical Student 4th Year, DO, Nova Southeastern University, Davie, FL; Nimesh Patel, MD, Ophthalmologist, Massachusetts Eye and Ear, Boston, MA; Nicolas Yannuzzi, MD, Ophthalmologist, Bascom Palmer Eye Institute of Miami Miller School of Medicine, Miami, FL; Jayanth Sridhar, MD, Ophthalmologist, Bascom Palmer Eye Institute of Miami Miller School of Medicine, Miami, FL.

Learning Objectives

  1. To describe the indications and outcomes following intraocular lens exchange;
  2. To understand the complications and reasons for repeat exchange following intraocular lens exchange.

BACKGROUND: Intraocular lens (IOL) exchange has been documented for reasons ranging from uveitisglaucoma-hyphema (UGH) syndrome to IOL decentration.[1] However, recent studies have shown a shift in indications for an exchange.[2] Additionally, in available literature, there has been poor consensus on indications for and visual outcomes of intraocular lens exchanges.[2]

DESIGN: Patients at Bascom Palmer Eye Institute that underwent IOL exchange recorded from 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: Intraocular lens 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), subluxation (n=52), UGH (n=35), broken haptic (n=22), refraction error (n=20), corneal edema (n=18), floaters or halos (n=17), dysphotopsia (n=17), vitreous prolapse (n=14), haptic erosion (n=13), and trauma (n=12). The most common lenses used for IOL exchange were Alcon MA60AC (n=116), Alcon MTA3/4/5UO (n=113), Akreos AO60 (n=88), ABBOTT Tecnis PCB00 (n=37), Alcon MA50BM (n=37), and ABBOTT Tecnis ZA9003 (n=19). Postoperatively, the average 3 months and final examination BCVA in logMAR were calculated to be 0.513 ± 0.521 (Snellen: 20/65) and 0.521 ± 0.672 (Snellen: 20/66), respectively. The most frequent complications following IOL exchange were cystoid macular edema (n=38), corneal edema (n=34), elevated intraocular pressure (n=27), epiretinal membrane (n=22), vitreous hemorrhage (n=19), hyphema (n=12), and glaucoma (n=12). Fourteen (n=14) out of the 21 reoperations were indicated for secondary IOL exchange due to dislocation, subluxation, VH, UGH, corneal edema, and dysphotopsia. The remaining 7 reoperations were indicated for either hypotony, wound leak, corneal perforation, RD, elevated IOP, secondary glaucoma, or NVG.

CONCLUSION: The settings for which IOL exchange is necessitated depend upon evaluating the clinical history of the patient, assessing the extent of associated ocular pathology, minimizing future complications, and maximizing the visual prognosis.

References and Resources:

  1. Davies, E.C. and R. Pineda, 2nd, Intraocular lens exchange surgery at a tertiary referral center: Indications, complications, and visual outcomes. J Cataract Refract Surg, 2016. 42(9): p. 1262-1267.
  2. Jones, J.J., Y.J. Jones, and G.J. Jin, Indications and outcomes of intraocular lens exchange during a recent 5-year period. Am J Ophthalmol, 2014. 157(1): p. 154-162 e1.