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Shedding light on removal of foldable IOLs: annual survey

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The decentration and dislocation of lens is key reason for explantation.

The American Society of Cataract and Refractive Surgery and the European Society of Cataract and Refractive Surgeons recently surveyed their membership about the factors that require explanation of foldable intraocular lenses (IOLs) or secondary interventions.

Nick Mamalis, MD, a professor of ophthalmology and visual sciences at University of Utah School of Medicine and codirector of Intermountain Ocular Research Center and director of the ophthalmic pathology laboratory at John A. Moran Eye Center at University of Utah Health, Salt Lake City, USA, discussed the findings by the organizations.

He said that survey participants were asked to enumerate the signs, symptoms, and complaints; the preoperative visual acuities; complications requiring removal or exchange; and secondary interventions. The designs of the IOLs included were 1-piece plate lenses, 1-piece lenses with haptics, 3-piece lenses, and multifocal and accommodating lenses; the lens materials included silicone, hydro- phobic acrylic, hydrophilic acrylic (hydrogel), and collamer.

The results showed that when all IOL types were considered, dislocation and decentration were the most common complications in 40% of cases, followed by glare and optical aberrations in 21%, iritis and uveitis-glaucoma-hyphema syndrome in 11.4% of cases, and calcification in 4.8%. Retinal detachments, IOL removal during retinal surgery, and infections were rare and occurred in 1% each.

Effects of design and material

The dislocations and decentration occurred most often in association with 1- and 3-piece acrylic IOLs and 1-piece silicone IOLs, according to Mamalis.

Mamalis also reported that the number of explantations of multifocal IOLs in-creased, and the most common reasons for explantation of these lenses were glare and optical aberrations. Incorrect lens power was the third most common reason for explantation.

Most reports of calcification of IOLs occurred in patients with hydrophilic acrylic IOLs.

Pearls for avoiding complications

Mamalis pointed out the best steps to avoid complications when implanting foldable IOLs. Good surgical techniques are essential. In addition, creation of a continuous curvilinear capsulorhexis, accurate IOL measurements, and proper patient selection and preoperative counseling are also important factors.

“The most common complications with fold-able IOLs were dislocation and decentration, glare and optical aberrations, and incorrect lens power,” Mamalis concluded. “These complications have changed little over the past 5 years and may be avoided by excellent surgical technique, accurate IOL measurements, and proper patient selection.”

Nick Mamalis, MD
E: nick.mamalis@hsc.utah.edu
Mamalis is a professor of ophthalmology and visual sciences at University of Utah School of Medicine and codirector of Intermountain Ocular Research Center and director of the ophthalmic pathology laboratory at John A. Moran Eye Center at University of Utah Health in Salt Lake City. He is a speaker for and consultant to several IOL manufacturers.


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