Intraocular lens exchange surgery in dissatisfied patients with refractive intraocular lenses

Purpose: To evaluate surgical outcomes after intraocular lens (IOL) exchange of refractive IOLs in dissatisfied patients. Setting: Bascom Palmer Eye Institute, Palm Beach Gardens, Florida, USA. Methods: This retrospective case series comprised dissatisfied patients who sought consultation and subsequently had IOL exchange surgery to remove a refractive IOL. Data collected included preoperative subjective and objective findings, surgical technique, and postoperative course. Results: Ten patients (12 eyes) had IOL exchange. All patients had subjective visual symptoms before IOL exchange surgery. Despite this, the preoperative corrected distance visual acuity (CDVA) was 20/30 or better in all eyes. During IOL exchange surgery, a monofocal IOL was placed in the capsular bag or the ciliary sulcus. Adjunctive anterior vitrectomy was performed as indicated for vitreous prolapse. The median follow-up after IOL exchange surgery was 8.9 months. Eight patients (10 eyes) were satisfied with the results of the IOL exchange surgery, while 2 patients said their initial symptoms persisted after the exchange. The CDVA was 20/25 or better in 9 eyes at 1 month. The CDVA in the remaining 3 eyes improved to 20/25 or better at 3 months (2 patients) or 6 months (1 patient). One patient had a complicated postoperative course that necessitated repeat IOL exchange with scleral fixation due to inadequate capsule support. Another patient had corneal decompensation after the IOL exchange surgery. Conclusion: Results show that IOL exchange is a feasible option for dissatisfied patients with persistent visual symptoms after refractive IOL placement.