Intraocular Lens Explantation Following Cataract Surgery: A Four-Year Retrospective Study

To assess the demographics, surgical indications and clinical outcomes of patients with lens (IOL) exchange after cataract surgery.

Department of ophthalmology, Habib Thameur University hospital, Tunis.

A retrospective descriptive study carried out at the Ophthalmology department of Habib Thameur University Hospital of Tunis between January 1^st 2018 and December 30^th 2021. We included 13 eyes of 13 patients that underwent surgery to exchange the IOL. Patient’s medical records were assessed for surgical indications, time since initial operation, procedure techniques and preoperative and postoperative best corrected distance visual acuity (BCVA). Comparative Mann Whitney and chi-squared tests were performed using 21.0 SPSS.

Three males and 10 females were eligible for the study. Mean age was 71.08 years. The average time between initial and final operations was 37.78 months. Pseudoexfoliation syndrome was present in 46 % of the eyes. During the first operation, the IOL was implanted in the sulcus in 31% and in the bag in 69%. After final surgery, the IOL was in the sulcus in 23 %, in the bag in 23%, in the anterior chamber in 23%, and fixated to the iris in 31%. Indications for secondary surgery were IOL dislocation in 46% of cases and damaged IOL in 46% of cases; the IOL was opacified in 23%, broken in 15% and degenerated in 8% of eyes. Refractive error was found in one eye (8%). Postoperatively, the median of BCVA improved from 2 to 0.4. (p=0.002).

Intraocular lens exchange after cataract surgery is unusual but may be associated with suboptimal visual outcome. IOL exchange is a challenging valuable treatment option for a wide range of problematic IOL findings. The most common indication is IOL opacification and dislocation, although patient dissatisfaction and refractive errors are increasingly common.