Changing indications for and improving outcomes of intraocular lens exchange

Abstract

Purpose: To evaluate the indications for and outcomes of intraocular lens (IOL) exchange at the same clinical setting over the past decade, as well as compare the efficacy and safety of anterior chamber lens (AC-IOL) and posterior chamber lens (PC-IOL) implantation for IOL exchange.

Design: Retrospective, nonrandomized case series.

Methods: The charts of all patients who had an IOL exchange at the Eye Institute of Utah between January 1998 and December 2004 were reviewed. The rate, indications, and outcomes are compared with the data of our previous study conducted between 1986 and 1990.

Results: This study comprised 51 eyes of 51 consecutive patients. The rate of IOL exchange was 0.77% of all cataract surgeries during the time considered. Incorrect IOL power (41.2%), decentration/dislocation (37.3%), and glare (7.8%) were the most common indications for IOL exchange. An AC-IOL was used in 14 eyes (27.5%) and a PC-IOL in 37 eyes (72.5%) for IOL exchange. None of the PC-IOLs was sutured to the sclera or iris. Overall, 90.2% of patients obtained a best-spectacle corrected visual acuity (BSCVA) of 20/40 or better. All eyes in AC-IOL group and 94.6% of eyes in PC-IOL group maintained within 1 line or improved 2 to 5 lines of the pre-exchange vision.

Conclusions: The improvements in IOL design and materials as well as surgical techniques have greatly minimized the incidence, changed the indications for, and improved the visual outcomes of IOL exchange over the past decade. Our study suggests that the open loop, flexible AC-IOL poses no greater risk than PC-IOL with respect to visual outcome and safety for IOL exchange. An AC-IOL may be preferable to a PC-IOL suture fixation for IOL exchange in the absence of posterior capsular support.