Diffractive Optic IOL Exchange: Indications and Outcomes

Endophthalmitis rates after secondary intraocular lens surgeries: 11-year Medicare fee-for-service analysis

PURPOSE

To assess postoperative endophthalmitis (POE) rates and risk factors after secondary intraocular lens (IOL) implantation for preoperative aphakia and IOL exchange combined with or without vitrectomy.

SETTING

Medicare fee-for-service (FFS) beneficiaries, United States.

DESIGN

Retrospective study.

METHODS

Medicare FFS beneficiaries who underwent IOL exchange or secondary IOL implantation for preoperative aphakia between January 1, 2011, and November 19, 2022, were identified. POE rates were calculated overall and separately for each surgical category-secondary IOL for aphakia vs IOL exchange, with subsets for concurrent anterior or posterior vitrectomy. Multivariate analysis of potential risk factors was implemented.

RESULTS

97 152 patients were included. The 42-day POE rates for secondary IOL implantation for aphakia and for IOL exchange were 0.35% and 0.28% overall, 0.31% and 0.30% when combined with posterior vitrectomy, and 0.84% and 0.42% with anterior vitrectomy, respectively. The risk of POE increased when secondary IOL surgery was combined with anterior vitrectomy compared with no vitrectomy (adjusted odds ratio [aOR], 1.849; P < .001) and with higher Charlson Comorbidity Indexes compared with 0: 1 to 2 (aOR, 1.495; P = .01), 3 to 4 (aOR, 1.591; P = .01), 5 to 6 (aOR, 1.617; P = .046), and ≥7 (aOR, 3.290; P < .001). Risk was decreased for IOL exchange compared with secondary IOL implantation for preoperative aphakia (aOR, 0.783; P = .04).

CONCLUSIONS

The overall POE rate for all secondary IOL surgeries was 0.31% during the 11-year period. We hypothesize that the absence of the posterior capsular barrier would explain the higher POE rates compared with cataract surgery, especially if a concurrent vitrectomy was performed with the secondary IOL procedure.

Managing dissatisfaction after multifocal intraocular lens implantation through lens exchange using monofocal or alternative multifocal IOLs

PURPOSE

To manage patient dissatisfaction following multifocal intraocular lens (MF-IOL) implantation by IOL exchange with either a monofocal or an alternative MF-IOL, and to compare outcomes in these two groups.

METHODS

MF-IOL exchange was performed in 32 patients (64 eyes) with neuroadaptation failure. The MF-to-MF group involved patients who had a MF-IOL exchanged with another MF-IOL of a different optical profile and the MF-to-MO group involved patients who had a MF-IOL exchanged to a monofocal IOL. Visual outcomes and complications were analysed. The Quality of Vision (QoV) questionnaire, Visual Function Index (VF-14) and its Rasch-revised version (VF-8R) were also used to assess outcomes.

RESULTS

There were no significant differences (p > 0.05) in the QoV scores between the two groups, both preoperatively and postoperatively. Preoperatively, there were no significant differences in VF-14 scores between both groups (p > 0.05). Postoperatively, there were statistically significant differences in VF-14 (total score, intermediate vision and near vision) in favour of the MF-to-MF group (p < 0.05). The postoperative VF-8R score in the MF-to-MF group was significantly better than the MF-to-MO group (p ≤ 0.001). Uncorrected and corrected near as well as corrected distance visual acuities were significantly better (p < 0.05) in the MF-to-MF group compared to the MF-to-MO group at 3 months.

CONCLUSION

Patient dissatisfaction and neuroadaptation failure following MF-IOL implantation can be managed by an IOL exchange with an alternative optical design of MF-IOL or a monofocal IOL. Although, in the current study, the MF-to-MF group showed some better postoperative results, both options are feasible solutions.

The Postoperative Visual and Refractive Outcomes of Trifocal and Extended Depth-of-Focus Intraocular Lenses in Patients with Different Biometric Characteristics

We aimed to survey the potential correlation between biometric parameters and postoperative outcomes after implanting extended depth-of-focus (EDOF) intraocular lenses (IOLs) and trifocal IOLs. A retrospective cohort study was conducted, and patients receiving EDOF or trifocal IOL implantations were included. In total, 36 and 26 eyes were enrolled in the EDOF and trifocal groups, respectively. The primary outcomes of this study were the postoperative uncorrected distance visual acuity (UDVA), uncorrected near visual acuity (UNVA), and spherical equivalent (SE). The generalized linear model was applied to evaluate the adjusted odds ratio (aOR) and 95% confidence intervals (CIs) of primary outcomes in patients with different biometric characters. The final UDVA of the EDOF group was significantly better than that of the trifocal group (p = 0.020), and the UNVA and SE did not show significant differences between the two groups throughout the postoperative period (all p > 0.05). In a multivariable analysis, the UDVA was significantly better in the EDOF group than in the trifocal group (p = 0.038). For the subgroup analysis, the high axial length (AXL) value correlated to a lower postoperative UDVA in the EDOF group (both p < 0.05). Additionally, a large white-to-white (WTW) diameter was related to worse postoperative UNVA in the trifocal group (p = 0.042), and a high AXL was associated with higher SE in both the EDOF and trifocal groups (both p < 0.05). In conclusion, a high AXL correlates to worse postoperative outcomes in both the EDOF and trifocal IOLs, and trifocal IOL outcomes could be affected by large WTW diameters.

BCLA CLEAR presbyopia: Management with intraocular lenses

Cataract surgery including intraocular lens (IOL) insertion, has been refined extensively since the first such procedure by Sir Harold Ridley in 1949. The intentional creation of monovision with IOLs using monofocal IOL designs has been reported since 1984. The first reported implantation of multifocal IOLs was published in 1987. Since then, various refractive and or diffractive multifocal IOLs have been commercialised. Most are concentric, but segmented IOLs are also available. The most popular are trifocal designs (overlaying two diffractive patterns to achieve additional focal planes at intermediate and near distances) and extended depth of focus designs which leave the patient largely spectacle independent with the reduced risk of bothersome contrast reduction and glare. As well as mini-monovision, surgical strategies to minimise the impact of presbyopia with IOLs includes mixing and matching lenses between the eyes and using IOLs whose power can be adjusted post-implantation. Various IOL designs to mimic the accommodative process have been tried including hinge optics, dual optics, lateral shifts lenses with cubic-type surfaces, lens refilling and curvature changing approaches, but issues in maintaining the active mechanism with post-surgical fibrosis, without causing ocular inflammation, remain a challenge. With careful patient selection, satisfaction rates with IOLs to manage presbyopia are high and anatomical or physiological complications rates are no higher than with monofocal IOLs.

Surgical outcomes of intraocular lens iris suture fixation in eyes with residual capsule support

PURPOSE

To evaluate the safety and refractive outcomes of eyes after intraocular lens (IOL) iris suture fixation (ISF).

SETTING

Private practice, Los Angeles, California.

DESIGN

Nonrandomized and unmasked retrospective chart review.

METHODS

Eyes that underwent IOL exchange or repositioning with ISF with at least 270 degrees of capsular support were included. Eyes with less than 270 degrees of capsular support and eyes with iris damage were excluded. The primary outcome measures included incidence of cystoid macular edema (CME), IOL dislocation requiring refixation, and chronic inflammation. Secondary outcome measures included worsening intraocular pressure (IOP) control, retinal tear or detachment, worsening of corrected distance visual acuity (CDVA), and corneal decompensation. Refractive outcomes for 26 subgrouped eyes included mean and median spherical equivalent refraction accuracy (SERA), and percentage of eyes within 0.5 diopter (D) and 1 D of the refractive target.

RESULTS

The study included 53 eyes of 50 patients. CME: 2/53 (3.8%), IOL dislocation requiring refixation: 2/53 (3.8%), chronic inflammation: 1/53 (1.9%), worsening IOP control: 5/53 (9.4%), retinal tear or detachment: 2/53 (3.8%). No patient experienced worsening of CDVA from baseline or corneal decompensation. Mean SERA ± SD -0.35 ± 0.29 D, median SERA -0.37 D. Of the 26 eyes subgrouped for refractive analysis, 73% were within 0.5 D and 100% were within 1 D of the desired refractive outcome.

CONCLUSIONS

ISF can offer stability for sulcus-fixated IOLs provided there is some residual capsule support. Although there are measurable complications, there is a relatively low side effect profile. The refractive error tended to be myopic, indicating the need for further refinement of IOL power predictive formulas.