Intraocular Lens Exchange by Anterior Segment Surgeons in a Tertiary Care Ophthalmology Centre -5209
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Author’s Disclosure Block: Kelly Ann Hutchinson, none; Harmanjit Singh, none; Stephanie Baxter, none; Davin Johnson, none
Abstract Body
Purpose: Intraocular lens (IOL) exchange is increasingly recognized as a core competency for anterior segment surgeons in managing cataract surgery complications and patient dissatisfaction. Characterizing the surgical indications and outcomes associated with this procedure is crucial to optimize patient care. Methods: This retrospective case series analyzed adult patients that underwent a surgical IOL exchange at the Kingston Health Sciences Center (KHSC) between 2019 to 2024 by one of two anterior segment surgeons. Patients were excluded if there was either repositioning of the lens without exchange, truncation/amputation of the lens haptic only, or aphakia after initial removal of the cataract with an IOL implanted in a subsequent procedure. Results: Twenty-six eyes from twenty-two patients were included in this series. On average, patients were aged 66.8 years old at the time of IOL exchange procedure. The average time interval between initial cataract surgery and IOL exchange was 2.3 years (27.4 months) and ranged between 21 days and 10.1 years. Eight eyes (30.8%) had a previous history of open capsule and/or YAG laser for posterior capsulotomy associated with the initial surgery. Peri- and post-operative complications were encountered in 3 eyes (11.5%). Indications for IOL exchange varied with the most common being dissatisfaction of vision with initial lens (46.2%) of which 75% (n=9/12) had a multi or trifocal lens.
Discussion: The most common indication for exchange in this cohort was found to be dissatisfaction of vision with initial lens. Moreover, while peri-and post-operative complications associated with IOL exchange may occur, most can be mitigated. Lastly, the average time between initial and repeat surgery was over 2 years with a maximum interval of 10.1 years. This finding highlights that prolonged time since initial surgery should not automatically preclude a patient from being considered for IOL exchange and is not necessarily an indicator of poor outcome.