Multifocal intraocular lens exchange in dissatisfied patients: a single surgeon’s experience — an update

Session Details

Session Title: IOL Dislocation & Opacification

Session Date/Time: Tuesday 25/09/2018 | 14:00-16:00

Paper Time: 15:12

Venue: Room A3, Podium 1

First Author: : D.Kazakos UK

Co Author(s): :                        

Abstract Details

Purpose:

To report an update of 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 2% of patients with MF-IOLs would be unhappy with their quality-of-vision and present a challenge in their management. IOLEx can address their issues however, it involves more intraocular manipulation and higher risks than the initial surgery especially in the presence of a YAG-laser posterior capsulotomy. 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 289 eyes of 201 consecutive patients who had IOLEx surgery between October 2014 and December 2017 were reviewed. Despite excellent UCDVA and UCNVAs with 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 both surgeries, type of lens used, reasons for IOL explantation, the time interval between surgeries, new IOL type used, intraoperative and postoperative course including patient satisfaction.

Results:

Four patients underwent IOLEx (from Tecnis-Symfony to Tecnis-ZLB/ZKB00) to improve their UCNVA. All other patients had IOLEx from a higher-add IOL: Oculentis MPlusX(41.3%), MPlus(49.6%), LenstecSBL-3(4.6%), FineVision-Trifocal(3.4%), Symfony-ZXR/ZXT(1.2%) to a lower-add IOL: Tecnis-Symfony(40%), Tecnis ZKB/ZLB(20%) Oculentis-Comfort(15%) or monofocal [Tecnis-ZCB00(20.7%), Tecnis-ZA9003(5.7%)]. There were 90 opacified Oculentis (various models) IOLs. The mean inter-surgical interval was 19.5 (1-74) months. Three patients had zonular-dialysis with a PC-tear two of which required vitrectomy and iris/sclera-fixated IOL, all others had intracapsular PC-IOLs. Twenty-one eyes had previous posterior YAG-laser capsulotomy. Mean follow up was 13.5 (1-36) months. All patients reported improved symptomatology. Eighty-eight patients (44%) required bilateral IOLEx.

Conclusions:

IOLEx may be an elective procedure or a necessity especially with opaque IOLs and carries more risks than the initial cataract or RLE surgery. Success in IOLEx depends on a full and honest discussion with the dissatisfied patient about his/her expectations, the risks of the surgery, appropriate choice of the replacing IOL type and surgical method based on the surgeon's skills and experience with the individual IOL types. Irrespective of the indication, IOLEx to a weaker MF-IOL is a feasible surgical option that can be performed safely with high patient satisfaction and excellent visual outcomes.

Financial Disclosure:

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