Abstract
PurposeTo investigate preoperative ocular risk factors and indications for secondary intraocular lens (IOL) implantation and compare postoperative complications, visual and refractive outcomes in a tertiary referral center.MethodsPatients older than 14 years that underwent secondary IOL implantation and had a minimum follow-up of 3 months were enrolled in this retrospective case series. Preoperative ocular risk factors, indications for surgery, postoperative complications, and visual and refractive outcomes including prediction error (PE) and absolute error (AE) were evaluated. IOLs were fixated in following positions: anterior chamber (AC), retropupillary iris-claw (IC), sulcus, and capsular bag or sclera.ResultsOne-hundred eighty-two eyes of 174 patients with mean follow-up of 17 ± 13.6 months were evaluated. Leading cause for surgery was IOL dislocation (75%), followed by secondary aphakia (19%) and IOL opacifications (6%). Previous vitrectomy was the major preoperative ocular risk factor (43%). Mean corrected distance visual acuity improved from preoperative 0.68 ± 0.55 to 0.42 ± 0.31LogMAR by the last follow-up (p = 0.001). PE and AE differed highly depending on the indication for surgery (p = 0.041 and p = 0.008, respectively) and the IOL fixation (p = 0.011 and p = 0.028, respectively), with IC-IOLs showing the lowest PE and AE. Postoperative AC-hemorrhage occurred mainly after IC-IOLs (p = 0.003), and postoperative hypotony was significantly higher in eyes with previous uveitis (p = 0.026).ConclusionsPrevious vitrectomy seems to be a major underreported risk factor in eyes that undergo secondary IOL implantation. Refractive outcomes depend on indication for surgery and fixation type, with retropupillary IC-IOLs providing the best refractive results, though not statistically significant compared to other IOL positions.
Highlights
After uneventful cataract surgery, a posterior chamber intraocular lens (IOL) (PC-IOL) is implanted in the capsular bag
IOL dislocation, aphakia, IOL opacifications, patient dissatisfaction after multifocal intraocular lens implantation, or UGH syndrome constitute the major reasons for surgery [5]
This study was conducted in order to examine the incidence of preoperative ocular risk factors and indications for surgery in a large European vitreoretinal referral center, and to compare the complications rate and the refractive and visual outcome
Summary
After uneventful cataract surgery, a posterior chamber IOL (PC-IOL) is implanted in the capsular bag This is not always possible, as capsular bag-associated complications may already exist preoperatively (loose zonula, IOL luxation) or occur intraoperatively (anterior or posterior capsular tear). In these cases, either no IOL will be implanted (aphakia) or the IOL has to be fixated in other positions such as anterior chamber (AC), iris, sulcus, or the sclera. In cases of secondary aphakia or IOL-related complications, a secondary intraocular lens implantation is the preferable This retrospective longitudinal case series was conducted in order to identify preoperative ocular risk factors and indications for secondary IOL surgery in a tertiary vitreoretinal referral center and compare the postoperative complications, refractive and visual outcome of such surgery. All secondary intraocular lenses were placed in one of the following positions: anterior chamber (AC, angle supported), retropupillary iris-claw fixation (IC-IOL), sulcus without optic capture, capsular bag, or trans-scleral fixation
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