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Most foldable IOL explantations still caused by dislocation, decentration

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COPENHAGEN — Dislocation and decentration remained the most common reason for IOL explantation among all lens designs studied, while glare and aberrations were the second most common, according to an annual survey.

Presented by Nick Mamalis, MD, at the European Society of Cataract and Refractive Surgeons meeting, the survey details patient complaints, symptoms and reasons for explantation or intervention among five different types of foldable IOL designs: one-piece with plate, one-piece with haptics, three-piece, multifocal and accommodating.

Nick Mamalis

While dislocation and decentration remained the main cause of removal for all lens types, the secondary reasons varied.

For hydrophobic acrylic one-piece lenses with haptics, incorrect lens power remains a problem, as it does with toric lenses, according to Mamalis.

“We thought we were doing better in decreasing the amount of lenses removed for incorrect lens power, but it’s still there,” Mamalis said.

The survey showed a “significant proportion” of three-piece hydrophobic acrylic lenses had been explanted due to iritis or uveitis-glaucoma-hyphema syndrome, whereas many hydrophilic acrylic lenses were removed due to calcification.

“Even though as the material gets better over time, we are still seeing calcification in these particular lenses,” Mamalis said.

Multifocal lenses, which have seen a recent increase in use and therefore an increase in explantations, differed from their monofocal counterparts in that glare, optical aberration and visual aberration resulted in many of their removals.

This survey shows that surgeons must continue stressing proper surgical technique and measurement, as well as conducting thorough patient consultations, Mamalis said.

“It is critical that these patients really know what to expect and that you’re putting these lenses in the proper patients,” he said. – by Rebecca Forand and Patricia Nale, ELS

Reference:

Mamalis N. ASCRS/ESCRS survey on foldable IOLs requiring explantation or secondary intervention: 2015 update. Presented at: 34th Congress of the European Society of Cataract and Refractive Surgeons; Sept. 10-14, 2016; Copenhagen, Denmark.

Disclosure : Mamalis reports no relevant financial disclosures.