IOL exchange can be safely performed in presence of open capsule
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VIENNA — Patients with dysphotopic symptoms who previously had a posterior capsulotomy can be reassured that IOL exchange is as safe as it is with an intact capsule, according to a study.
Although no clear evidence exists in support of this assumption, “surgeons and patients tend to be wary of IOL exchange in the presence of a previously opened posterior capsule,” Samuel Masket, MD, said at the European Society of Cataract and Refractive Surgeons meeting.
To verify whether there are added risks in the presence of an open vs. closed posterior capsule, Masket and colleagues performed a retrospective chart review of 90 eyes of 75 patients who underwent IOL exchange for purely optical purposes, with no associated comorbidities. Eyes were then divided into two groups, 38 with an open posterior capsule and 52 with a closed capsule.
Nearly 90% of eyes with an open capsule required anterior vitrectomy. More than half had the secondary IOL implanted with the optic capture technique, and about one-third had iris suture fixation. Patients with the intact capsule were able to have bag-to-bag exchange in 65% of the cases, and another 20% had iris suture fixation.
“Results were identical in terms of clinical and statistical significance with respect to postoperative complications, visual acuity and optical outcomes,” Masket said.
No meaningful difference was found between the two groups with regard to worsening IOP, cystoid macular edema, chronic inflammation, decreased best corrected visual acuity as well as retinal detachment and retinal tears. However, with regard to refractive outcomes, a significantly greater myopic error of approximately 0.75 D was found in patients who had open posterior capsules, likely due to the different fixation method of the secondary IOL.
“We feel that open posterior capsule patients can have lens exchange as safely as with a closed posterior capsule but that the refractive targets are more accurate if we go back inside the capsule bag. Most importantly, we feel that we can reassure our patients of the safety of doing this exchange if the capsule has been previously open,” Masket said.
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Masket S, et al. Outcomes of IOL exchange is the setting of an open or closed posterior capsule. Presented at: European Society of Cataract and Refractive Surgeons meeting; Sept. 8-12, 2023; Vienna.
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