Intraocular Lens Exchange For Opacified Intraocular Lenses: A Retrospective Study

To describe the surgical management and evaluate the clinical outcomes of intraocular lens (IOL) exchange in patients with an opacified IOL. 

Department of Ophthalmology, Habib Thameur University Hospital, Tunis, Tunisia.

A retrospective monocentric study from January 2020 to January 2023, comprising eyes with previous phacoemulsification and implantation of a single-piece hydrophilic acrylic IOL in the posterior chamber complicated with a late opacification of the IOL. All patients underwent IOL exchange. A new IOL was implanted in the sulcus or posteriorly fixated to the iris (P-IFIOL). The perioperative and postoperative complications were evaluated, and the best-corrected visual acuity (BCVA: decimal scale) before and after surgery were compared. 

Seven eyes of 7 patients were included. Mean age was 53 years. Mean time from the first surgery till IOL exchange was 6.2 years. The most used explantation method (6 eyes) involved prolapsing the IOL in the anterior chamber, cutting it with micro scissors and explanting the pieces through a corneal incision. A scleral tunnel was used for explantation in 1 eye. A new IOL was implanted in the sulcus in 6 eyes and P-IFIOL in 1 eye. Four of them were foldable three-piece IOLs, 2 were one-piece rigid PMMA IOLs, and 1 was a P-IFIOL. Perioperative complications included iris damage in 3 eyes. Postoperatively, transient ocular hypertonia and corneal edema were noted in 1 eye each. Mean BCVA improved from 0.05 to 0.5 before and after IOL exchange. 

IOL exchange is an effective solution in patients with loss of vision from opacified IOLs. There is no other currently available treatment option for this condition. Various explantation techniques can be employed with a common purpose of limiting the postoperative complications especially corneal endothelial cell loss.