Complications of Refractive Lens Exchange

Refractive lens exchange (RLE) has become an established option for the correction of refractive errors and presbyopia in appropriately selected patients. However, because the procedure involves removal of a clear crystalline lens, its potential complications and the appropriate limits of its indication require careful consideration. The objective of this review was to summarize the principal complications associated with RLE, with emphasis on their incidence, risk factors, prevention, and management.

Narrative review of the current literature on complications associated with refractive lens exchange.

RLE is generally safe and predictable in appropriately selected patients, but complications remain clinically relevant. Principal adverse outcomes include refractive surprise, multifocal IOL-related dysphotopsias and neuroadaptation failure, retinal detachment, cystoid macular edema, posterior capsule opacification, and other IOL-related complications. Their incidence varies according to patient characteristics, IOL type, and duration of follow-up. Retinal detachment represents the most serious vision-threatening complication, particularly in younger and highly myopic patients. Careful preoperative assessment, individualized IOL selection, and systematic evaluation of postoperative complaints are essential to minimize complications and improve patient satisfaction.

Safe application of RLE depends on individualized patient selection, comprehensive preoperative assessment, appropriate IOL selection, and realistic patient counselling. Because RLE involves the irreversible removal of a clear crystalline lens, its risks, benefits, alternatives, and ethical boundaries should be carefully considered before surgery.