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Study: Better IOL exchange results with sulcus or capsular bag lens placement

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Secondary implantation of an IOL in either the sulcus or the capsular bag during the exchange of opacified Hydroview IOLs resulted in significantly better visual outcomes than placing the lens in the anterior chamber, a prospective study found.

Rasha Altaie, FRCSI(Ophth), and colleagues at Waterford Regional Hospital, Ireland, evaluated outcomes for 73 eyes of 71 patients treated with IOL exchange for opacified Hydroview IOLs (Bausch & Lomb) at an average of 36.64 months after their primary cataract surgery. When possible, surgeons implanted the secondary IOL in the capsular bag. In cases of posterior capsular rupture or inadequate capsular support, surgeons instead placed the lens in either the sulcus or the anterior chamber, according to the study.

At 13 months mean follow-up, investigators noted a significant improvement in mean best corrected visual acuity, with 40 eyes (54.8%) achieving 6/12 or better, the authors reported. Seven eyes (9.6%) showed no significant change in BCVA, and six eyes (8.2%) lost some BCVA, they said.

"Paradoxically, it is worth noting that a deterioration in BCVA following exchange of opacified Hydroview IOLs is often accompanied by a large degree of patient satisfaction, presumably because of enhanced contrast sensitivity," the authors said. "This is because opacification of the Hydroview IOL adversely affects contrast sensitivity and visual acuity, but contrast sensitivity to greater extent."

In contrast to prior reports, secondary IOL placement in either the sulcus or the capsular bag resulted in significantly better BVCA compared with anterior chamber placement (P = .004), the authors noted.

"Longer follow-up may explain, at least in part, our finding ... since progression of age related maculopathy (ARM) and the development of epiretinal membrane (ERM) were noted in five (18.5%) of the eyes where an anterior chamber IOL was inserted," the authors said, noting that ARM and ERM have been "putatively linked" to intraocular inflammation.

Placing the secondary lens in the anterior chamber is necessary for cases with a disrupted barrier between the anterior and posterior segments, which may promote an inflammatory response, they said.

The study is published in the March issue of British Journal of Ophthalmology.