Surgical outcomes of intraocular lens exchange Five-year study

PURPOSE: To report the indications, surgical complications, and outcomes of intraocular lens (IOL) exchange procedures performed over 5 years and to correlate the incidence of perioperative anterior vitrectomy in eyes previously treated by neodymium:YAG (Nd:YAG) laser capsulotomy. SETTING: Department of Ophthalmology, Antwerp University Hospital, Edegem, Belgium. METHODS: In this prospective study, all IOL exchange procedures performed between October 2002 and December 2007 were included. Surgical outcomes were correlated with indications, IOL position, targeted versus achieved refraction, preoperative Nd:YAG laser capsulotomy, and surgical complications. RESULTS: One hundred twenty-eight eyes (113 patients) had IOL exchange because of IOL opacification (31%), IOL decentration (19%), IOL dislocation (18%), capsule phimosis (14%), corneal endothelial cell decompensation (8%), IOL miscalculation (6%), damaged IOL (2%), or IOL-related chronic uveitis (2%). Before and after IOL exchange, respectively, the IOL was capsule fixated in 82% and 45% of eyes, iris fixated in 4% and 39% of eyes, and sulcus fixated in 7% and 15% of eyes. Iris-fixated IOLs had the lowest predictability of refractive outcome (mean 1.55 diopters). Intraocular lenses implanted using the bag-in-the-lens technique had the highest refractive outcome predictability (mean 0.51 D). CONCLUSIONS: Decentration of pseudoaccommodating IOLs accounted for 14% of all IOL exchanges. Vitreous loss necessitating anterior vitrectomy was strongly correlated with preoperative Nd:YAG laser capsulotomy. J Cataract Refract Surg 2009; 35:1013-1018 (C) 2009 ASCRS and ESCRS