Replacement Of Intraocular Lens Due To Functional Discomfort. A Report On 13 Cases.

We present a series of thirteen eyes from ten patients. Their implants were replaced due to significant functional discomfort characterised predominantly by cloudy vision . Primary implantation was multifocal in eleven eyes and monofocal in two. Anterior segment swept-source OCT  were used to systematically determine the root of the functional problem.

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The patients were operated on consecutively between January 2021 and June 2023: seven women and three men with an average age of 69 years (58–80). Indications for treatment are a reduction in visual acuity to below 20/30(8/13), blurred vision (4/13) and refractive instability (1/13). Mean pre-operative visual acuity is 20/30 (20/80-20/20) and 54% of the eyes are unable to read Jaeger 1. OCT swept-source examination shows implant decentration (10/13), lens tilt (3/13) and a kappa angle greater than 400 microns (4/13). Functional impairment is exacerbated by age-related maculopathy (2/13) or marked corneal aberration (2/13).

After surgery, mean visual acuity is more than 20/30, 77% are able to read Jaeger . Initial impairment is completely resolved, except in one patient who suffers a marked vertical coma post-LASIK. Mean sphere is -0.50 (-1.75–+0.25); mean astigmatism 0.55 (-0.75–+0.75). Mean tilt is 6.3⁰; mean horizontal decentration is 0.3mm; mean vertical decentration 0.25mm. Two implants have to be repositioned using sutured scleral fixation: one because of a 9.65⁰ tilt and decentration which had caused an internal astigmatism of 2 dioptres; the other for a troublesome cystoid macular oedema linked to UGH syndrome. In both cases the axial length is 21.50mm.

With premium implants being increasingly used in cataract surgery, it is important that we remain aware of their limitations. In the event of an unexpected post-operative problem, it is crucial to take the decision to replace the implant as quickly as possible. Thereby avoiding the complications associated with complex surgery on short eye which is where we most often see these indications.