Intraocular lens exchange surgery at a tertiary referral center: Indications, complications, and visual outcomes

PURPOSE: To identify indications for and visual outcomes of intraocular lens (IOL) exchange to understand recent changes in this surgery. SETTING: Academic tertiary referral center. DESIGN: Retrospective case series. METHODS: Cases were identified by searching the institution's electronic medical records from January 2010 to September 2015 for patients treated by 1 staff physician with the American Medical Association's Current Procedural Terminology code for IOL exchange. These cases were reviewed to determine the surgical indication, type of IOL removed, type of IOL implanted, time between surgeries, surgical complications, and visual outcomes. RESULTS: The study comprised medical records of 109 eyes. The mean time between the primary cataract surgery and IOL exchange was 1657 days. Dislocation of an in-the-bag posterior chamber IOL (27.5%), intolerance of a multifocal IOL (18.3%), and uveitis-glaucoma-hyphema syndrome (11.9%) were the most frequent indications for IOL exchange. The final IOL position after exchange was most frequently in the capsular bag (43.1%), anterior chamber (25.7%), or sulcus (22%). The final visual acuity at 1 month was 20/40 or better in 78.9% of cases. Of those not achieving this level of acuity, pathology not related to exchange surgery was identified in 48% of cases. The most frequent complications after IOL exchange surgery were posterior capsule opacification (13.8%), cystoid macular edema (10.1%), and high astigmatism (>1.5 diopters) (8.3%). CONCLUSIONS: The most frequent indication for IOL exchange surgery was dislocated IOLs; the second most frequent indication was patient dissatisfaction after multifocal IOL implantation. The increased ability to place an intracapsular IOL with few intraoperative complications and largely treatable postoperative complications enhances the effectiveness of IOL exchange surgery and patient satisfaction.