INTRAOCULAR LENS EXCHANGE AFTER CATARACT SURGERY: INCIDENCE, INDICATIONS, AND OUTCOMES AT A TERTIARY EYE CARE CENTER IN GERMANY

The purpose of this study is to assess the incidence and the causes of IOL exchange after cataract surgery as well as to report the visual outcomes, complications and the different techniques used for secondary IOL implantation.

Augenklinik Ahaus, Germany.

Patients who underwent both IOL exchange and their initial cataract surgery at our clinic between Jan 1, 2016 - Jan. 1, 2022 were included in this retrospective study. We reviewed the medical records to determine the cumulative incidence of IOL exchange surgeries performed and the surgical indication for IOL explantation. We also investigated pre-existing ocular comorbidities and conditions, the time interval betw. the two operations, complications, outcomes of IOL exchange surgery and surgeon‘s choices in secondary IOL implantation, i.e. lens selection and location of implantation.

Betw. Jan. 1, 2016 - Jan. 1, 2022, a total number of 26,377 eyes underwent phacoemulsification with IOL implantation at our clinic. Of those, 59 eyes (right: 35 (59.3%), left: 24 (40.7%)) of 59 patients (males: 36 (61%), females: 23 (39%)) had IOL exchange surgery in the same period. The mean patient age at the time of IOL exchange was 67.68 ± 11.85 years. The cumulative incidence of IOL exchange was 2.2 per 1,000 cataract operations over 6 years. The main indication of IOL explantation was IOL dislocation 24 (40.6%), followed by incorrect IOL power 21 (35.6%), patient dissatisfaction due to halos and glare 9 (15.3%), IOL opacification 4 (6.8%) and capsular contraction 1 (1.7%). Glaucoma was the most common ocular condition, accounting for 11 (18.6%) of all cases, followed by high myopia (10 (16.9%), pseudoexfoliation syndrome 6 (10.2%),diabetic retinopathy 4 (6.8%), floppy iris 5 (8.5%), age-related macular degeneration 3 (5.1%), and other conditions 7 (11.9%). The time interval betw. the cataract and the IOL exchange was 10.5 ± 15.35 months. The types of the secondary implanted IOLs were: monofocal IOL 19 (32.2%), iris-claw IOL 18 (30.5%), 3-piece IOL 12 (20.3%), EDOF IOL  8 (13.6%), and multifocal IOL 2 (3.4%). 33 (55.9%) of the IOLs were implanted in the bag, 18 (30.5%) were retropupillary-fixated and 8 (13.6%) were sulcus-fixated. The mean visual acuity before the IOL exchange surgery was 0.29 ± 0.27 in LogMAR compared to 0.18 ± 0.20 after the surgery (p < 0.001). The mean intraocular pressure before the IOL exchange surgery was 15.13 ± 3.89 mmHg, compared to 15.83 ± 4.40 after the surgery (p = 0.291). Vitreous prolapse was the most common intraoperative complication 21 (35.6%) and secondary cataract was the most common postoperative complication 9 (15.3%).

Advancements in modern cataract surgery in terms of surgical techniques and utilised technologies have lowered the rate of IOL exchange surgery and altered the percentages of its main indications. IOL dislocation remains to be one of the most common indications for IOL explantation. IOL exchange surgery appears to have a good safety profile and visual outcomes.