Study investigates causes, risk factors and outcomes of IOL exchange
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WAILEA, Hawaii — IOL exchange may occur at a higher rate in eyes implanted with presbyopia-correcting IOLs than monofocal IOLs. Exchange outcomes are overall satisfactory but better with monofocals, according to a study.
“While this procedure does convey risk ... you can have very good results with an improved visual experience,” Terry Kim, MD, said at Hawaiian Eye 2024.
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The study, performed at Duke University Eye Center, included 91 eyes of 83 patients who underwent IOL exchange over a period of 4 years; 66 were monofocal IOL exchanges, and 25 were presbyopia-correcting IOL exchanges. The mean time to exchange was about 84 months for the monofocal group and 17 months for the presbyopia-correcting IOL group.
Indications for exchange were quite different between the groups. The most prevalent was dislocation for monofocal IOLs and photic phenomena, including glare, halos and blurry vision, for presbyopia-correcting IOLs.
Vision improved significantly after monofocal IOL exchange, from 20/296 to 20/97 uncorrected and from 20/61 to 20/38 best corrected.
“If you look at that same data for the presbyopia-correcting IOL group, not as big a difference, but certainly we saw that difference when we looked at patient satisfaction and quality of vision questions, which we collected subjectively,” Kim said.
In both groups, the risk of undergoing IOL exchange increased in cases with previous ocular procedures, the majority of which were retinal detachment repair or pars plana vitrectomy in the monofocal IOL group and refractive procedures in the presbyopia-correcting IOL group. Complications occurring during cataract surgery were also a risk factor.
Postoperative complications with IOL exchange occurred in 11 cases and included suprachoroidal hemorrhage, cystoid macular edema, irregular astigmatism, Descemet's stripping endothelial keratoplasty graft failure and persistent corneal edema requiring endothelial keratoplasty.
“Surgeons should consider these risk factors, such as the complexity of their cataract surgery initially and other previous surgeries, and discuss exchange and complications with their patients,” Kim said.
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Kim T. Indications, outcomes, and techniques of intraocular lens exchange. Presented at: Hawaiian Eye 2024; Jan. 13-19, 2024; Wailea, Hawaii.
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