When The Solution Is Worse Than The Problem

To report a case in which the result of IOL exchange surgery was worse than the initial opaque lens vision. Intraocular lenses (IOLs) can opacify after being implanted. When this occurs, an ophthalmic evaluation is necessary to analyze the risks and benefits, since the intraocular lens replacement surgery is, most of the times, a complex procedure. Our case aims to present an unsuccessful IOL exchange, as well as to discuss the importance of non-medical intervention and assessment of the patient's level of satisfaction before surgery.

Public University Hospital

A 79-year-old male patient was in consultation 3 years prior, and an opacified intraocular lens (IOL) was observed in the left eye, with surprising visual acuity of 20/20. In a subsequent consultation, IOL exchange was indicated. However, during surgery, the capsular support was compromised and, in the end, the new IOL became decentered. Nine months after surgery, the IOL is touching the ciliary body and the patient has low vision, corneal edema, glaucoma and exotropia. This case illustrates that indications for surgery should always be individualized, weighing risks and potential benefits. A thorough and detailed preoperative clinical examination is essential and, sometimes, opacities can be misleading.

IOL exchange surgery is a challenging procedure and can have sight-threatening complications. Decision to perform surgery must be individualized and the pros and cons must be fully disclosed. IOL opacification can be misleading and vision may be preserved even in densely opacified lenses.