Saloon Door Technique – “open sky” IOL exchange utilising flanged haptic fixation behind a pre-existing Artificial Iris

This Issue At A Glance

To describe our experience with exchanging sulcus-fixated single-piece intraocular lens (IOL) with 3-piece IOLs for management of pigmentary glaucoma. In this retrospective study, records of patients who underwent sulcus-fixated single-piece IOL exchanged with 3-piece IOLs were retrieved, and demographic and baseline data of patients, type of IOL, pre- and post-IOL exchange BCVA, IOP, number of anti-glaucoma medications, and optic nerve head examination were documented. Baseline and final examinations were analyzed and compared. Mean age of the patients was 59±10years, and 5 (41.6%) were female. Mean interval between primary cataract extraction operation and IOL exchange was 17±5months. Nine patients received in sulcus implantation of Alcon SA60AT, and three patients had SN60WF model at the end of primary surgery. BCVA changed insignificantly from 0.06±0.06 logMAR to 0.06±0.06 after IOL exchange. (P=0.22) IOP was controlled in 8 cases (66.6%), but four cases (33.3%) needed glaucoma surgery to further control glaucoma condition. IOP decreased significantly from preoperative 17±3 to 14±1mmHg postoperatively. Patients with advanced age and higher baseline IOP were more likely to undergo glaucoma surgery after IOL exchange. (P=0.07 and 0.00, respectively). single-piece IOL exchange with 3-piece IOL dramatically decreases pigment release and reduces IOP. Those with advanced age and higher IOP are less likely to respond to IOL exchange and may need glaucoma surgery to control high intraocular pressure.

Sulcus-fixated intraocular lens implantation for the management of negative dysphotopsia

Intraocular lens explantation and exchange: A review of lens styles, clinical indications, clinical results, and visual outcome

Intraocular lens exchange surgery in dissatisfied patients with refractive intraocular lenses

Glued Trans-scleral Intraocular Lens Exchange for Anterior Chamber Lenses in Complicated Eyes: Analysis of Indications and Results

The purpose of this study was to compare the surgical outcomes of intraocular lens (IOL) refixation with intraocular lens exchange using perfluorocarbon liquid (PFCL) and fibrin glue-assisted sutureless scleral fixation surgery in patients with dislocation of the IOL. Twenty-five eyes of 25 patients who underwent surgery for dislocated IOLs with PFCL and fibrin glue-assisted scleral fixation were studied; 13 eyes experienced IOL refixation (in-the-bag and out-of-the-bag), and 12 eyes experienced IOL exchange. Preoperative and postoperative clinical features from patient charts and 25 eyes with >6 months' follow-up information were reviewed and analyzed. At postoperative 6 months, best-corrected visual acuity (BCVA) and spherical equivalent of IOL refixation and exchange were significantly improved (P=0.042, P=0.001), and endothelial cell density was significantly decreased in the two groups with no significant difference between them. Surgically induced astigmatism of IOL refixation improved from 0.90±0.47 to 0.61±0.37 (P=0.012), and IOL exchange improved from 1.17±0.64 to 0.73±0.37 (P=0.037) at postoperative 6 months, with no significant difference between the two groups. Complications occurred in four eyes in the IOL refixation group and in three eyes in the IOL exchange group. PFCL and fibrin glue-assisted IOL sutureless scleral refixation or exchanged fixation was an effective surgical treatment for IOL dislocation. Also, because postoperative BCVA, surgical outcomes, and complications did not differ significantly between IOL refixation and exchange surgery, if IOL exchange surgery is not indicated, IOL refixation surgical techniques should be considered.

Intraocular lens exchange with removal of the optic only

PurposeTo determine the indications and surgical outcomes of intraocular lens (IOL) exchange in pseudophakic patients at Labbafinejad Tertiary Referral Center between 2014 and 2019.MethodsIn this retrospective interventional case series, the medical records of 193 patients with a history of IOL exchange were reviewed. Preoperative data, including clinical characteristics, indications of the first and second IOL implantation, intra- and postoperative complications due to IOL exchange, and the pre-and postoperative refractive error and best-corrected visual acuity (BCVA) were considered the outcome measures in this study. All postoperative data were analyzed at least six months after follow-up.ResultsThe mean age of our participants was 59.13 ± 20.97 years old at the time of the IOL exchange, with a male percentage of 63.2%. The mean follow-up after the IOL exchange was 15.72 ± 16.28 months. The main indications of IOL exchange were IOL decentration (50.3%), corneal decompensation (30.6%), and residual refractive errors (8.3%). 57.10% of patients with the postoperative spherical equivalent at -2.00 diopter (D) to + 2.00D. The mean best-corrected visual acuity was 0.82 ± 0.76 LogMAR before the IOL exchange and was improved to 0.73 ± 0.79 LogMAR after the surgery. Corneal decompensation (6.2%), glaucoma (4.7%), retinal detachment (4.1%), cystoid macular edema (2.1%), and uveitis (1%) were found as the postoperative complications. There was only one case with suprachoroidal hemorrhage during IOL exchange.ConclusionsIOL decentration followed by corneal decompensation was the most common indication of IOL exchange. After IOL exchange, the most complications during follow-up were corneal decompensation, glaucoma, retinal detachment, and cystoid macular edema.

We present an analysis of 101 eyes of 98 consecutive patients who underwent intraocular lens (IOL) exchange. The period of follow up ranged from 6 to 71 months (mean, 23 months). Bullous keratopathy was the leading (86.7%) indication for IOL exchange in 45 eyes that had combined penetrating keratoplasty (PKP) and IOL exchange (PKP group). Lens dislocation (36%) and incorrect power (25%) were the most frequent indications for IOL exchange without PKP (56 eyes) (NPKP group). A final visual acuity of 20/40 or better was achieved in 50.5% of the 101 eyes, with 88% having two lines of improvement or remaining within one line of the pre-exchange acuity. The geometric mean visual acuity was significantly improved, from 20/273 preoperatively to 20/125 postoperatively, in the PKP group (P less than .001), and from 20/61 to 20/43 in the NPKP group (P = .001). The main reason for vision less than 20/200 in the 23 eyes in the PKP group was glaucoma (nine eyes) and bullous keratopathy (eight eyes). In the NPKP group, seven eyes (four due to cystoid macular edema, CME) had a visual acuity less than 20/200. Posterior chamber (PC) IOL implantation was associated with significantly better visual acuity than anterior chamber (AC) IOL implantation when performed at IOL exchange (P = .004). The most common complications encountered with IOL exchange were CME (17.8%), hyphema (15.8%), glaucoma (10.9%) and PC opacity (8.9%).

Surgical outcomes of intraocular lens exchange: Five-year study

Penetrating keratoplasty with intraocular lens (IOL) exchange is generally recommended for eyes with pseudophakic bullous keratopathy, especially when the keratopathy is associated with uveitis, chronic cystoid macular edema, or a uveitis-glaucoma-hyphema syndrome. Review of the literature has shown basically equivalent long-term results of penetrating keratoplasty and IOL exchange using both Kelman-style, flexible, open-loop anterior chamber lenses and acapsular fixation of sutured posterior chamber lenses. The use of suture-fixated posterior chamber IOLs appears warranted in centers where the surgeon has extensive experience with this specific technique and in cases with special indications, for example, in eyes with extensive angle abnormalities. However, because this technique is more difficult to perform, and in the absence of such preexisting contraindications, for most practices we do not hesitate to recommend the use of a Kelman-style anterior chamber lens during routine cases of penetrating keratoplasty and IOL exchange.

Pathologic Comparison of Asymmetric or Sulcus Fixation of 3-Piece Intraocular Lenses with Square Versus Round Anterior Optic Edges

To apply a previously published scleral fixation technique to secure one-piece acrylic intraocular lenses (IOLs) to the sclera. Retrospective, consecutive, noncomparative case series. All patients (16 eyes of 15 patients) who underwent scleral fixation of 1-piece acrylic IOLs using the loop method from 2014 to 2016 were included. The mean follow-up was 8.1 months. Repositioning of dislocated 1-piece acrylic IOLs was performed in 8 eyes, a primary implantation in 5 eyes, and IOL exchange in 3 eyes. All IOLs remained well-centered postoperatively. The vision improved from an initial best-corrected visual acuity of 0.97 ± 0.74 logMAR (Snellen equivalent ≈20/190) to 0.47 ± 0.49 logMAR (≈20/60, P = 0.031) at the last follow-up. The postoperative complications were self-limited. The previously reported scleral suture fixation technique can be readily applied to one-piece acrylic IOLs.

To evaluate the indications, lens styles, perioperative findings, and results of intraocular lens (IOL) explantation or exchange performed in the authors department in 2005. The retrospective analysis comprised 22 patients (23 eyes). Twenty-one eyes had previous phacoemulsification and IOL implantation, one eye secondary aphakic IOL, and one eye phakic IOL implantation. The indications for IOL explantation/exchange and perioperative complications were evaluated. The best-corrected visual acuity (BCVA) before and after surgery was compared. Time from initial surgery to explantation/exchange varied from 1 to 121 months, median value was 46 months. The IOLs were explanted using local anesthesia and in 21 eyes replaced with new lens. Indications for IOL removal were opacification of the IOL in 12 eyes, malposition of the IOL in 5 eyes, postoperative refractive error in 2 eyes, recurrent toxic anterior segment syndrome in 1 eye, pseudophakic dysphotopsia in 1 eye, endothelial cell loss in phakic anterior chamber IOL in 1 eye, and visual discomfort with intraocular telescopic lens in 1 eye. The mean BCVA (decimal scale) before and after IOL explantation/exchange was 0.562+/-0.279 and 0.627+/-0.276, respectively. There was no significant difference in visual acuity before and after IOL exchange (Wilcoxon test). The most frequent indications for IOL explantation/exchange were opacification of the IOL and IOL malposition. Surgeries were uneventful in most cases. Final visual results have been largely good. Long-term follow-up of patients with various types of IOLs should be maintained.