A 10-YEAR AUDIT OF INTRAOPERATIVE INTRAOCULAR LENS (IOL) ASSOCIATED COMPLICATIONS AT A TERTIARY EYE HOSPITAL

To determine the frequency, type, and outcomes of intraoperative intraocular lens (IOL) associated complications over a 10-year period in a high-volume tertiary centre. Although rare, IOL-related complications can significantly impair visual outcomes, necessitate additional procedures, and increase healthcare burden. By systematically reviewing long-term data, we aimed to establish complication rates, assess trends over time, evaluate associations with operative factors, and understand reporting practices. The results are essential for benchmarking surgical outcomes and improving safety standards.

Moorfields Eye Hospital NHS Foundation Trust, a high-volume tertiary ophthalmic centre performing over 25,000 cataract operations annually, with complication rates consistently lower than national averages.

Retrospective audit of cataract operations performed between January 2014–December 2023, using OpenEyes electronic health records. Cases were identified through documentation of intraoperative IOL-related complications. Data extracted included demographics, operative details, lens type, coexistent surgical complications, and requirement for further surgery. Cases without clear IOL involvement were excluded. Extraction was performed by multiple authors using a standardised proforma and collated in Microsoft Excel for analysis.

From 176,663 cataract operations, 193 IOL-associated complications were identified (0.11%). Four cases were excluded due to misclassification. Mean age was 69.4 years (range 3–97), with 47.4% male. 79.5% involved the default SN60WF lens option. Complications occurred at a consistent rate across the 10 years. 28.9% of cases were associated with other intraoperative complications, including 16.0% posterior capsule rupture and 12.1% requiring vitrectomy. The most common reported complication was a necessary unplanned IOL-exchange (69.8%), generally due to an observed defect post-implantation or requirement of a 3-piece IOL. Other complications included IOL dislocation into the vitreous (7%) and decentred IOL (3%). Overall, 14.3% of patients required further surgery.

Intraoperative IOL complications remain rare (0.11%) and stable over a decade. While most occur in isolation, a proportion are associated with other complications, such as posterior capsule rupture. Reporting inconsistency across surgeons highlights the need for standardised definitions and structured complication documentation. Improved capture will enhance surveillance and benchmarking across centres.