Outcomes Of Iol Exchange Is The Setting Of An Open Or Closed Posterior Capsule

The purpose of the investigation was to determine the added risks, if any, associated with IOL exchange in the presence of an open versus a closed posterior capsule in patients requiring lens exchange surgery for purely optical purposes (dysphotopsia, multifocal intolerance, opaque IOL, etc.) absent IOL malpositioning. In addition, refractive outcomes of the two groups was to be considered.

Advanced Vision Care, Los Angeles CA USA

Specialty Surgery Center, Beverly Hills, CA USA

The investigation was a nonrandomized retrospective chart review of 90 eyes (38 open posterior capsule (OPC) and 52 closed posterior capsule (CPC)) of 75 patients (51 female) who underwent IOL exchange for purely optical purposes between June 2009 and July 2022. Mean age was 65.4 years (48-82 years range).

Primary outcome measures: Incidence of surgical complications between the OPC and CPC study groups, including worsening IOP control (IOP ≥ 10mmHg from baseline), post-operative chronic inflammation > 3months, cystoid macular edema (CME), retinal tears/detachments, visually significant vitreous hemorrhage, worsening of CDVA from baseline, and corneal decompensation.

Secondary outcome measures: Refractive outcomes 

87% of the eyes in OPC and none in the CPD required vitrectomy. Three eyes in the OPC group and 2 eyes in the CPC group had worsening IOP control that required medication or laser trabeculoplasty. Two eyes in the OPC group and 2 eyes in the CPC group had CME that resolved with topical agents. One patient in the OPC group had chronic inflammation > 3 months that resolved with NSAIDs. One eye in the CPC group had a retinal tear. One eye in the OPC group had decreased CDVA after surgery due to CME and one eye in the CPC group had decreased CDVA after surgery due to (VMT). None of the post-operative complications reached statistical significance between the groups.

The OPC group exhibited a statistically greater optical (myopic) error.

The results of our investigation are interesting with respect to two findings. One is that that the rates of postoperative complications were not meaningfully different for the two groups and the second was that the accuracy of the optical outcomes was superior for the group with closed posterior capsules. Given the low incidence of surgical complications in this cohort, we feel comfortable in advising patients that having an IOL exchange for optical purposes following laser posterior capsulotomy appears to be safe and not meaningfully different for those eyes with intact posterior capsules.