Intraocular lens exchange through a 3.2-mm corneal incision for opacified intraocular lenses

Abstract

Aim:The aim was to evaluate visual and refractive results and complications of intraocular lens (IOL) exchange through a 3.2 mm corneal incision for opacified IOLs.Materials and Methods:This retrospective study comprised 33 eyes of 32 patients with IOL opacification requiring an IOL exchange between July 2003 and March 2007. Exchange surgery was performed through a 3.2-mm temporal clear corneal incision followed by implantation of a new foldable hydrophobic IOL. Uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), topographical astigmatism, and refractive cylinder were evaluated. Surgically induced astigmatism (SIA) was calculated and complications were recorded.Results:Opacification was observed in 25 eyes (76%) with Aqua-Sense, 3 eyes (9%) with Hydroview, 3 eyes (9%) with MemoryLens IOLs, and 2 eyes (6%) with DgR. The mean follow-up period was 36.54 months. An uneventful IOL exchange was achieved in 18 eyes (55%). Zonular dehiscence occurred in 9 eyes (27%), and posterior capsule tear developed in 4 eyes (12%). The mean preoperative BSCVA (mean ± standard deviation, decimal scale) was 0.13 ± 0.08 (mean: 20/150, range 20/2000 to 20/60) and improved to 0.63 ± 0.18 (mean: 20/32, range 20/60 to 20/20, P < 0.001). The mean SIA was 0.70 D. Seven eyes (21%) had 0.5 D or lower SIA.Conclusion:IOL exchange is a technically challenging procedure with potential risks of reversing the advantages of a prior small-incision cataract surgery. The use of a small corneal incision for IOL exchange could preserve the advantages of modern phacoemulsification surgery with acceptable SIA related to the procedure.

An Unusual Case of Opacified Intraocular Lens Exchange After 50 Months: A Case Report

“…The time interval between initial cataract surgery and IOL exchange in our patient was 50 months. This is in comparison to the cases presented by Anil Kubaloglu et al with 27.69 ± 11.18 months and Seung Mo Kim et al with 60.4 ± 7.4 months [4,6]. No conclusive pattern could be deduced on the timeline of the opacification.…”

“…The majority of surgical techniques include removing the IOL after cutting the optic; however, the intraocular scissors may damage the posterior capsule. Posterior capsule rupture has been reported at 12%, 9%, and 8.6% by Kubaloglu, Dagres, and Lee and in their studies, respectively [4,5,9]. Another common complication is zonular dehiscence due to difficulty in separating the haptics from the fibrosed capsule [5].…”

“…IOL exchange is an uncommon and challenging procedure, and IOL exchange due to IOL opacification is even rarer, with an incidence of 1% [4]. The cause of opacification is yet unknown, but as mentioned previously, calcium phosphate hydroxide deposits are commonly formed as a result of a chemical reaction and seen under the surface of IOL [3].…”

“…These deposits have been found to be present in a granular fashion in both the haptics and the optics regions of the lens [3]. As these deposits and consequently the opacification caused by them lead to a substantial decrease in visual acuity, it becomes imperative to perform an IOL exchange using a surgical technique that presents minimal risks [4]. As IOL exchange is a fairly risky surgical procedure that can result in a number of complications, including posterior capsule rupture and zonular dehiscence, predominantly caused by adhesions between the opacified IOL and the capsule [5], we aim to report an interesting case to familiarize ophthalmologists and healthcare professionals with the surgical technique that comes with minimal risks of capsule rupture and zonular dehiscence that we employed to do a successful in-the-bag to in-the-bag IOL exchange after almost four years.…”

Post operative opacification of polymethylmethacrylate, hydrophilic and hydrophobic acrylic intraocular lenses: A retrospective observational study

“…11 Duration of IOL opacification ranged from 10 minutes after the surgery to seven years or more. 12,13 Silicone, acrylic, and polymethylmethacrylate (PMMA) IOL have been reported to opacify. Hydrophilic IOLs have more tendency of opacification in comparison with hydrophobic IOLs as primary calcification occurs more in hydrophilic IOLs as compared with hydrophobic IOLs.…”