Abstract
Intraocular lens (IOL) exchange after cataract surgery is unusual but may be associated with suboptimal visual outcome. The incidence of IOL exchange has not been consistently estimated. Such information is invaluable when counseling patients prior to cataract surgery. We examined the incidence of, and indications and risk factors for, IOL exchange after cataract surgery. We also assessed visual outcome of eyes that had an IOL exchange. A cohort design was used to estimate the incidence of IOL exchange and a case-control design to identify factors associated with it. All phacoemulsification surgeries with IOL (n = 17415 eyes) during 2010–2017 and those that had a subsequent IOL removal or replacement during the same time period were identified (n = 34 eyes). The incidence of IOL exchange was 2 per 1000 surgeries (95% confidence interval [CI] 1 to 3) over 8 years. Eyes that underwent subsequent IOL removal or replacement were compared with eyes that had cataract surgery only (n = 47) across demographic and clinical characteristics. In a binary logistic regression analysis, two factors were significantly associated with IOL exchange/removal: an adverse event during cataract surgery (adjusted odds ratio [aOR] 19.45; 95% CI 4.89–77.30, P < 0.001) and a pre-existing ocular comorbidity (aOR 10.70; 95% CI 1.69–67.63, P = 0.021). The effect of gender was marginally significant (P = 0.077). Eyes that underwent IOL exchange or explantation were nearly two and a half times more likely to have a final best-corrected visual acuity of <20/60 compared to those that had cataract surgery alone (adjusted RR 2.60 95% CI, 1.13–6.02; P = 0.025).
Highlights
Age-related cataract remains the leading cause of blindness worldwide, despite the fact that cataract surgery is one of the most frequently performed and cost effective surgical interventions to date[1,2,3,4,5]
Several retrospective studies have looked at the risk factors for and visual outcomes after intraocular lens (IOL) removal/ exchange[10,11,12,13,14,15]
To the best of our knowledge this is the first study to report the incidence of IOL removal/ exchange (2 per 1000 cataract surgeries (95% confidence interval [confidence intervals (CI)] 1 to 3, over 8 years, corresponding to an average annual incidence of 2.5 per 10,000)
Summary
Age-related cataract remains the leading cause of blindness worldwide, despite the fact that cataract surgery is one of the most frequently performed and cost effective surgical interventions to date[1,2,3,4,5]. Potentially vision-threatening complications may occur in a small proportion of patients. Most of these complications (estimated incidence) have been extensively studied including endophthalmitis (0.05–0.15%)[6], retinal detachment (0.39%)[7], and expulsive hemorrhage (0.05–0.1%)[8]. Less severe and often seen as a late complication, the need for intraocular lens (IOL) exchange after primary cataract surgery is unusual and may lead to suboptimal visual outcome[9,10,11,12,13,14,15]. We examined the risk factors for, and visual outcomes after intraocular lens (IOL) removal/exchange after cataract surgery
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