Intraocular lens exchange or explantation post cataract surgery

AIM:To report incidence,indications,and visual outcomes of intraocular lens(IOL)exchange/explantation surgery.METHODS:Retrospective analysis of 60 eyes requiring IOL exchange/explantation surgery between 1^(st) January 2017 and 31^(st) December 2022.The overall outcomes as well as comparison between the trainee versus experienced surgeons were analyzed.RESULTS:Out of 39778 cataract surgeries(with no preexisting ocular co-morbidities)during a six-year period(2017-2022),60(0.15%)needed IOL exchange/explantation.Surgeons-under-training performed 36/60 cases(60%)while 24/60(40%)were by experienced surgeons.The commonest indication was subluxated IOL in 26(43.3%),followed by dislocated IOL in 20(33.3%),postoperative refractive surprise in 7(11.6%),IOL induced uveitis in five and broken haptic in two eyes.Twenty-four(40%)eyes had intraoperative complications during primary surgery.Posterior chamber IOL(PCIOL)was the commonest secondary IOL in 21(35%)eyes,scleral fixated in 20(31.6%),anterior chamber IOL(ACIOL)in 13(21.6%),iris fixated IOL in three(5%)and three eyes(5%)were left aphakic.The mean time between primary and secondary surgery was 168d(168±338.8).Best corrected visual acuity(BCVA)of>20/60 was obtained in 43 eyes(71.66%),20/80-20/200 in 14(23.33%),20/250 in two and hand movements in one.No statistically significant difference in visual outcome was noted at post-op one month between trainees versus experienced surgeons(UCVA 0.45±0.29 vs 0.53±0.32,P=0.20,BCVA 0.34±0.25 vs 0.37±0.26,P=0.69).CONCLUSION:IOL subluxation as the commonest indication and posterior capsular rupture is the commonest intraoperative risk factor.This complication can be effectively addressed with selection of the appropriate secondary IOL achieving good visual outcomes in over 70% of patients.

High speed small gauge anterior vitrectomy cutter for scleral fixated intraocular lens implantation

AIM： To report the outcomes of anterior vitrectomy using high speed cutter for scleral fixated intraocular lens （SFIOL） implantation in patients with posterior capsular rupture .METHODS： Medical records of 51 patients with posterior capsular rupture who received high speed cutter anterior vitrectomy via limbal incision with SFIOL implantation from June 2011 to December 2013 were reviewed retrospectively for visual outcomes and complications.RESULTS： Totally 51 eyes of 51 patients were identified （23 males and 28 females）. Mean age at surgery was 67.2±15y （range 27-91y）, with mean follow-up of 23±8.2mo （range 12-40mo）. The 49 （96.1%） eyes had improvement or unchanged of final postoperative visual acuity. The most common complication was vitreous haemorrhage （5.9%） and transient rise in intraocular pressure （5.9%） which all spontaneously resolved CONCLUSION： High speed cutter anterior vitrectomy via limbal incision is a safe and effective method for those with posterior capsular rupture for SFIOL implantation.