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The Moorfields experience of secondary intraocular lens procedures: IOL exchanges, IOL revisions and secondary IOL implantation outcomes – visual rehabilitation after cataract surgery

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Session Details

Session Title: Cataract Surgery Outcomes

Session Date/Time: Tuesday 16/09/2014 | 08:00-10:30

Paper Time: 08:00

Venue: Capital Hall A

First Author: : J.Ho UK

Co Author(s): :    S. Robbie   B. Hussain   A. Ionides        

Abstract Details


To analyse the indications, outcomes and complications of secondary intraocular lens (IOL) procedures performed in a recent 9 year period (2003-2012).


Retrospective consecutive case-note review of IOL exchange, IOL repositioning and secondary IOL insertions undertaken at a large national ophthalmic tertiary referral centre (Moorfields Eye Hospital, London, UK).


119 eyes from 115 patients were retrospectively evaluated for pre-operative ocular comorbidities/risk factors, primary procedure and initial complications, reasons for secondary procedure, intra- and post-operative secondary intraocular lens procedure complications, IOL type and final position, final best-corrected visual acuity (BCVA) and refractive outcomes.


26 IOL exchanges, 10 IOL repositioning procedures and 83 secondary IOL insertions were performed. Secondary IOL insertion for aphakia (55%) and IOL subluxation/dislocation (23.5%) were the most common reasons for secondary intraocular lens surgery. 7.5% of cases were performed for refractive reasons (undesired acuity, anisometropia, astigmatism, refractive surprise). 66% had prior ocular comorbidities and 19% had undergone vitreo-retinal surgical intervention prior to the secondary IOL procedure. The median final BCVA was LogMAR 0.18 (Snellen 6/9) and mean final spherical equivalent was -0.72 D. 30% experienced post-operative complications, the most common being uveitis (9%) and CMO (8%). 67% of cases had final BCVA of 6/12 or better; 46% of those with final BCVA worse than 6/12 had a contributing ocular comorbidity.


Patient expectations have risen with the development of modern lenses and improved surgical techniques and instruments. Despite the risk of post-operative complications, our complex case-mix from a tertiary referral population shows that good final visual acuity outcomes can still be safely achieved from carefully planned secondary intraocular lens surgical procedures in challenging eyes with multiple ocular comorbidities and previous surgeries.

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