Indications and outcomes of intraocular lens exchange during a recent 5-year period

To analyze and classify the indications, clinical presentations, and surgical outcomes of intraocular lens (IOL) exchange performed in a recent 5-year period.

Retrospective, interventional case series.

setting: Private clinical practice. study population: Chart records of 57 eyes of 53 consecutive patients who had undergone IOL exchange between May 2007 and December 2011 were reviewed. observation procedures and main outcome measures: The preoperative clinical characteristics, treatment parameters, intraoperative and postoperative complications, and pre- and postoperative logarithm of the minimal angle of resolution (logMAR) best-corrected visual acuity (BCVA) were recorded and analyzed.

IOL dislocation (46%), incorrect IOL power (23%), patient dissatisfaction (21%), and optic opacification (7%) were the most common indications for IOL exchange. In the IOL dislocation group, posterior capsule opening presented in 57% of eyes (8/14) with in-the-bag dislocation. Of the dissatisfaction patients, 42% (5/11) had undesired visual acuity without symptoms of glare/optical aberrations. Surface calcification of silicone lenses associated with asteroid hyalosis accounted for the most cases (3/4) of optic opacification. Overall, the mean logMAR BCVA improved significantly (P < .001) and 88% of all eyes were 20/40 or better, including 73% in the IOL dislocation group and 100% in all other groups. No vision-threatening complications occurred in this series.

The request for IOL exchange owing to patient dissatisfaction is increasing, especially for those with undesired visual acuity in the absence of photic symptoms. Surface calcification of silicone lenses suggests that this type of lens is not appropriate in the presence of asteroid hyalosis. Optimal visual results with a low rate of complications can be achieved in each category of indication. The findings of the study may stimulate discussion of a question: Does in-the-bag IOL dislocation occur only in eyes with an intact posterior capsule?