When The First Lens Isn't The Last: Incidence, Indications, And Outcomes Of Iol Exchange: A 10-Year Retrospective Review In A German Tertiary Hospital

To determine the incidence, indications, and visual outcomes of intraocular lens (IOL) exchange after cataract surgery over a 10-year period at a German tertiary eye center. Secondary objectives included analyzing the time interval between primary surgery and exchange, identifying the most frequent indications for reoperation, evaluating pre- and postoperative visual acuity and complication rates.

Augenklinik Ahaus - Fachkrankenhaus, Ahaus, North Rhine-Westphalia, Germany.

Retrospective single-center review of all IOL exchanges performed after cataract surgery at a tertiary eye hospital in Germany over a 10-year period (January 2016–January 2026). Only patients whose primary cataract surgery and IOL exchange were both performed at our center were included. Cumulative incidence was calculated as IOL exchanges per total cataract surgeries. Data encompassed demographics, indications, time to exchange, ocular comorbidities, explanted and secondary IOL characteristics, implantation site, and complications.

Among 50,410 phacoemulsification procedures over 10 years, 115 eyes (102 patients) required IOL exchange (cumulative incidence: 2.28/1,000; 95% CI: 1.88–2.74), with no significant temporal trend (IRR: 1.021; P = 0.534). Mean time to exchange was 16.7 ± 26.73 months. Leading indications were dislocation (37.4%), dissatisfaction (29.6%), and incorrect power (25.2%); glaucoma was the most common comorbidity (17.4%). Secondary IOLs were iris-claw (31.3%), monofocal (29.6%), three-piece (18.3%), EDOF (14.8%), and multifocal (6.1%), placed in-the-bag (53.9%), retropupillary (31.3%), or sulcus (14.8%). Most frequent complications complications were intraoperative vitreous prolapse (29.9%) and postoperative posterior capsule opacification (13.7%).

IOL exchange remains an infrequent procedure following cataract surgery, with a stable incidence of 2.28 per 1,000 operations over a 10-year period. The growing availability of contemporary IOL designs and ongoing refinements in biometry and IOL power calculation may have contributed to a shift in the spectrum of indications, with patient dissatisfaction representing a notable proportion alongside the traditionally dominant indication of IOL dislocation. Overall, IOL exchange demonstrated a favorable safety profile, supporting its role as an effective option for appropriately selected patients.