Intraocular lens exchange in dissatisfied patients: a large case series

Session Details

Session Title: Cataract Surgery Complications/Management

Session Date/Time: Monday 12/09/2016 | 16:30-18:15

Paper Time: 17:00

Venue: Auditorium C6

First Author: : D.Kazakos UK

Co Author(s): :                        

Abstract Details

Purpose:

To report my personal experience on the effectiveness and patient satisfaction of Intraocular Lens exchange (IOLEx) in a high volume of unhappy patients with MF-IOLs after RLE or cataract surgery. Around 1% - 2% of patients with MF-IOLs would be unhappy with their quality of vision and increasingly present a challenge in their management. IOLEx is one of the methods addressing their issues however, it is an invasive surgery involving more manipulation and higher risks than the initial surgery. These include: posterior capsular tear, zonular dialysis, vitrectomy, corneal endothelial damage, iris tissue damage, retinal detachment and postoperative CME.

Setting:

Optical Express, London, UK

Methods:

This retrospective case series comprised of dissatisfied patients who were referred for consultation and IOLEx surgery. Records of 160 eyes of 153 consecutive patients who had IOLEx surgery between October 2014 and March 2016 were reviewed. Despite excellent UCDVA and UCNVAs from bilateral MF-IOLs, all patients suffered varying degrees of poor Quality of Vision (lack of focus, glare, ghosting, mistiness). Data collected included visual parameters prior to and after the initial surgery, type of lens used, reasons for IOL explantation, time interval between surgeries, new IOL type used, intraoperative and postoperative course including patient satisfaction.

Results:

Three patients underwent IOLEx (from Tecnis-Symfony to Tecnis-ZLB00) to improve their UCNVA. All other patients had IOLEx from a higher-add IOL: Oculentis MPlusX (39%), MPlus (42%), Lenstec SBL-3 (5.1%), FineVision-Trifocal (3.8%), Symfony-ZXR/T (5.7%) to a lower-add IOL: Tecnis-Symfony ZXR/T (71%), Oculentis-Comfort (2.6%) or monofocal [Tecnis-ZCB00 (15.7%), Tecnis-ZA9003 (7.7%)]. The mean intersurgical interval was 19.6 (0.3-75) months. Two patients had zonular-dialysis with a PC-tear one of which required vitrectomy and iris-fixated IOL, all others, had intracapsular PC-IOLs. Mean follow up was 9.5 (1-17) months. All patients reported improved symptomatology and only 7 patients (4.6%) required IOLEx of their second eye as well.

Conclusions:

IOLEx is not a routine surgery and carry more risks than the initial cataract/RLE procedure. The key to success in IOLEx is a full and honest discussion with the dissatisfied patient about his/her expectations, the risks of the surgery, customised IOL selection, appropriate choice of surgical method based on the surgeon's skills and experience with individual IOL types. Irrespective of the indication, IOLEx of the dominant eye to a weaker MF-IOL is a feasible surgical option, can be performed safely with high patient satisfaction and excellent visual outcome. In this study no patient lost BCDVA.

Financial Disclosure:

NONE