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Intraocular lens exchange in dissatisfied patients: A single surgeon’s experience

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Session Details

Session Title: Refractive
Session Date/Time: Sunday 28/02/2016 | 08:30-11:00
Paper Time: 09:24
Venue: Skalkotas
First Author: : D.Kazakos UK
Co Author(s): :                  

Abstract Details


To report my personal experience on the effectiveness and patient satisfaction of intraocular lens exchange (IOLEx) in a high volume of unhappy patients.


Optical Express, London, UK


This retrospective case series comprised dissatisfied patients who were referred for consultation and IOLEx surgery. Records of 88 eyes of 81 consecutive patients who had IOLEx surgery between October 2014 and October 2015 were reviewed. Despite excellent UCDVA and UCNVAs from bilateral MF-IOLs, all patients suffered varying degrees of poor Quality of Vision (lack of focus, glare, ghosting, mistiness). Data collected included visual parameters prior to and after the initial surgery, type of lens used, reasons for IOL explantation, time interval between surgeries, new IOL type used in the dominant eye, intraoperative and postoperative course including patient satisfaction.


One patient underwent IOLEx (from Tecnis-Symfony to Tecnis-ZLB00) to improve his UCNVA. All other patients had IOLEx from a higher-add IOL: Oculentis MPlusX (43%), MPlus (41%), Lenstec SBL-3 (5.7%), FineVision-Trifocal (4.5%), Symfony-ZXR (2.3%) to a lower-add IOL: Tecnis-Symfony (60%), Oculentis-Comfort (15%) or monofocal [Tecnis-ZCB00 (20.7%), Tecnis-ZA9003 (5.7%)]. The mean intersurgical interval was 17.5 (1-74) months. Two patients had zonular-dialysis with a PC-tear one of which required vitrectomy and iris-fixated IOL, all others, had intracapsular PC-IOLs. Mean follow up was 5.1 (1-13) months. All patients reported improved symptomatology and only 7 patients (8.6%) required IOLEx of their non-dominant eye as well.


IOLEx is not a routine surgery and carry more risks than the initial cataract/RLE surgery. The Keys for success in IOLEx is a full and honest discussion with the dissatisfied patient about his/her expectations, the risks of the surgery, customised IOL selection, appropriate choice of surgical method based on the surgeon's skills and experience with individual IOL types. Irrespective of the indication, IOLEx of the dominant eye to a weaker MF-IOL is a feasible surgical option, can be performed safely with high patient satisfaction and excellent visual outcome. In this study no patient lost UCDVA or BCDVA.

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