Secondary Intraocular Lens (Iol): 5-Year Experience In The Vitreoretinal (Vr) Service

The main purpose of this study is to assess referral reasons for secondary IOL to the VR service and to determine the most common secondary IOL selected. In addition, we also determined the best corrected visual acuity (BCVA) and complications of secondary IOL implants.

There is an increasing trend to refer to the VR service for secondary IOL implantation. After extraction of the natural lens, an IOL is ideally implanted in the capsular bag, However, pre-existing problems such as dehisced zonules may have occurred, in addition to intraoperative complications such as posterior capsule rupture. Furthermore, traumatic dislocation of the natural lens or IOL, and longstanding aphakia from childhood lenticular problems may also warrant secondary IOL implantation.

This is a retrospective review of all consecutive patients >18 years of age referred to the vitreoretinal service in a tertiary hospital from January 2019 to September 2024 for secondary intraocular lens (IOL) implant. The exclusion criteria were eyes where decision was made to leave aphakic. All secondary IOL implantation were performed by a single surgeon (DP). Secondary IOL in this review include anterior Artisan, retro-pupillary Artisan, sulcus lens and scleral-fixated lens, which were performed using the Yamane technique.

87 eyes included in this study were categorized based on indications:complicated cataract surgery(43.6%), crystalline lens dislocation(21.8%), dislocated IOL(24.1%), longstanding aphakia(7%) and UGH syndrome(3.4%). The mean pre-operative BCVA was 1.33logMAR, which improved to 0.33logMAR post-operatively. This difference was most significant in the complicated cataract surgery group. UGH group had highest mean axial length(25.85mm) followed by dislocated IOL group(24.69mm); most of these eyes had posterior Artisan implanted. In terms of complication, sulcus IOLs had highest dislocation occurrence, all of which required intervention. Posterior Artisans had two cases of corneal oedema requiring corneal grafts.

In our setting, complicated cataract surgery seemed to be the most common referral reason for secondary IOL. This cohort also appeared to have the most significant improvement in BCVA. We noted a wide variation in complications, and these were shown to be more dependent on type of secondary IOL implants than indication for secondary IOL.