Indications and outcomes for the removal of intraocular lens implants in a retinal surgery practice

BACKGROUND AND OBJECTIVE: To describe the reasons for and clinical outcomes of intraocular lens (IOL) removal, with or without exchange, in the setting of retina surgery. PATIENTS AND METHODS: This is a retrospective, non-comparative, consecutive, interventional case series of patients undergoing IOL removal at an academic referral center performed by a single surgeon between 2002 and 2013. Data collected included baseline patient characteristics, visual acuity (VA), type of IOL, reason for IOL removal, and postoperative complications. RESULTS: The study cohort included 63 eyes with IOL removal. Of these, 51 (81%) were left aphakic. For cases of IOL opacification or dislocated IOL (56), the decision to remove was made for 35 (63%) during concurrent retinal surgery due to obstruction in visualization. Overall, the most common reason for removal of the IOL was IOL opacities in 42 eyes (67%), followed by nonspecific nature of opacities (n = 19; 45%), oil artifact (n = 17; 40%), opaque nonvascular membranes (n = 4; 10%), and fibrovascular proliferation (n = 2; 5%). Other causes for removal were IOL dislocation (n = 14; 22%), endophthalmitis (n = 7; 11%), and broken IOL haptic (n = 1; 2%). The composition of the 42 IOLs with opacification included 19 (45%) silicone, 14 (33%) unspecified, five (12%) polymethyl methacrylate, and four acrylic (10%). From the 17 IOLs removed due to oil opacification, 15 (83%) were silicone, and two (17%) were unspecified. Postoperative complications included recurrent retinal detachment (n = 13; 21%), hypotony (n = 8; 13%), phthisis bulbi (n = 8; 13%), corneal edema (n = 7; 11%), cystoid macular edema (n = 5; 8%), elevated intraocular pressure (n = 3; 5%), vitreous hemorrhage (n = 3; 5%), hyphema (1; 2%), anterior synechiae (1; 2%), and sub-retinal hemorrhage (1; 2%) The mean (SD) immediate, 3 months, and fnal best-corrected VA in logMAR were 2.18 (0.47), 1.85 (0.82), and 1.97 (0.85). CONCLUSION: The vitreoretinal surgeon must be prepared for IOL removal, especially if IOL opacification and dislocation compromise the view or capability to achieve primary retinal reattachment objectives.