Secondary IOL procedures generally have satisfactory visual outcomes

There are many reasons why patients may need secondary procedures, particularly in eyes with ocular comorbidities, but modern surgical techniques can usually provide a good visual  result, said Jason Ho FRCS, UK.

Dr Ho presented a retrospective consecutive case-note review of the indications, outcomes and complications of secondary intraocular lens (IOL) procedures performed at Moorfields Hospital from2003-2012).

During that period, 26 IOL exchanges, 10 IOL repositioning procedures and 83 secondary IOL insertions were performed at the centre. The most common indications for the secondary procedures  were IOL insertion for aphakia (55 per cent) and IOL subluxation/dislocation (23.5 per cent). A further 7.5 per cent  underwent the secondary procedures for refractive reasons, including  unsatisfactory visual  acuity, anisometropia, astigmatism, and refractive surprises.

Over all, 66 per cent  had prior ocular comorbidities and 19 per cent  had undergone vitreo-retinal surgical intervention prior to the secondary IOL procedure.

Following the secondary procedures, the patients median final BCVA was LogMAR 0.18 (Snellen 6/9) and their mean final spherical equivalent was -0.72 D. Two- thirds of patients had a final BCVA of 6/12 or better. Among those with final BCVA worse than 6/12, 46 per cent had a contributing ocular comorbidity.

 There were post-operative complications in 30 per cent of cases, the most common being uveitis (nine per cent) and CMO (eight per cent).

“Despite the risk of post-operative complications,our complex case-mix from a tertiary referral population shows that good final visual acuity outcomes can still be safely achieved from carefully planned secondary intraocular lens surgical procedures in challenging eyes,” Dr Ho concluded.