41 - Intraocular Lens Exchange and Secondary Intraocular Lens Placement

Abstract

Secondary intraocular lens (IOL) placement is necessary for patients who require implantation of an IOL after primary cataract surgery. There are many indications including patient dissatisfaction, trauma, IOL malpositioning, uveitis-glaucoma-hyphema syndrome, and aphakia. Although the optimal placement of an IOL is captured within the capsular bag, eyes that require secondary IOLs often do not have adequate capsule support. In these cases, iris-fixated, scleral-fixated, or anterior chamber lenses should be considered. Traditionally, these secondary lenses have higher risks of complications including uveitis, corneal decompensation, and IOL dislocation. Newer techniques and IOL designs have decreased these risks and have resulted in excellent anatomic and refractive outcomes. Particularly promising are newer techniques for sutureless scleral-fixated lenses, first described by Yamane, in which the haptics of a three-piece IOL are externalized through the sclera and cauterized to create a bulb. This chapter reviews the most common indications for secondary IOL placement, options for IOL placement, brief surgical techniques, and the available data on advantages and disadvantages of these options.