Intraocular lens exchange through a 3.2-mm corneal incision for opacified intraocular lenses

Visual and refractive outcome, higher order aberrations and complications following intraocular lens exchange in eyes without comorbidities

Intraocular lens (IOL) exchange is performed to treat severe IOL-related complications. There is little published data on the impact of this procedure on the refractive outcomes and intra- and postoperative complications, especially in otherwise healthy eyes. We investigated the refractive outcome of IOL exchange surgery, including corneal aberrations; additionally, we assessed the influence of different IOL characteristics on intraoperative and postoperative complications. This prospective clinical study included 35 eyes with homogenous IOL calcification without other ocular pathologies. Using Pentacam AXL Wave (Oculus Optikgeräte GmbH, Wetzlar, Germany), corrected distance visual acuity (CDVA), target refraction compared to the postoperative spherical equivalent, corneal topography and lower and higher-order aberrations were assessed preoperatively and from 3 months after surgery. Intraoperative and postoperative complications were recorded and compared between different IOL characteristics. The secondary IOL in 53% of cases, was a retropupillary iris-fixated Artisan Aphakia (Ophtec BV, Groningen, Netherlands), 37% had a sulcus-fixated AR40e (Johnson & Johnson Vision, Irvine, USA), and 10% had a capsular bag IOL. The CDVA improved from 0.16 ± 0.14 to 0.07 ± 0.14 logMAR (p = 0.04). In most cases, the target refraction was within ± 1.0 D (Artisan: 71%, AR40e: 90%, Capsular: 100%). IOL exchange did not induce relevant change in corneal aberrations. Anterior (81%) and posterior (78%) vitrectomy were performed in most cases. The haptic design of the primary IOL did not impact intra- or postoperative complications. Although exchanging an IOL involves greater surgery compared to the initial IOL implantation, visual and refractive outcomes are good, and the exchange does not cause relevant change in aberrations. Intra- and postoperative complications are mostly mild and resolve without sequelae.

Intraoperative Intraocular Lens Waste: Incidence, Cost and Reasons

PURPOSE

To evaluate the incidence and cost of intraocular lens(IOL) waste during IOL implantation, as well as the reasons for it.

METHODS

A retrospective analysis was conducted on the data of 485 patients from the IOL waste registers of a single tertiary eye hospital in China during 2016-2020. The primary outcomes were the incidence, cost, and reasons for different IOL properties. Cases were examined to ascertain IOL material, design, procedural details, and causes of waste.

RESULTS

IOL waste occurred in 485 (6.62‰) of the 73,246 IOL implantations during the study period. The total cost of IOL waste was 429, 850.26 Chinese Yuan (CNY) related to waste with an average cost of 2, 442.33 CNY per procedure during the study period. Comparisons between IOL properties showed that polymethyl methacrylate (PMMA) material (39, 2.05%), three-piece design (142, 1.49%), and secondary IOL implantation (26, 2.16%) were associated with IOL wastage, and the difference was statistically significant. The causes of IOL waste were damage (107, 60.80%), patient reasons (37, 21.26%), aseptic errors (22, 12.50%), IOL quality problems (8, 4.55%), and loss (2, 1.14%).

CONCLUSIONS

The incidence of IOL waste is low, but still leads to a significant cost burden due to a large number of cataract surgeries. PMMA material, three-piece design, and secondary implantation were identified as factors increasing IOL waste. Damage emerged as the primary reason for waste, largely attributed to human error. Therefore, the development of strategies to mitigate IOL waste is imperative.

Direct Intraocular Lens Extraction Using a Newly Developed Lens-Grabbing Forceps

Background: Due to lower age thresholds for cataract surgery and increased longevity, cases with intraocular lens (IOL) dislocation requiring removal have increased. Traditional methods, such as cutting or folding the IOL within the eye, pose a high risk of complications, including corneal endothelial and iris damage. Methods: We developed a new minimally invasive technique for direct IOL removal using specially designed lens-grabbing forceps. These forceps can grasp and remove the IOL through a small incision in a single motion, significantly reducing intraocular manipulations compared to conventional methods. Results: In our test cases, IOL removal through a 2.2 mm corneal incision was completed in approximately 95 s, with minimal incision enlargement (about 0.16 mm) and a slight decrease in corneal endothelial cells. Conclusions: Our findings suggest that this technique is minimally invasive and safe for IOL removal, offering a promising alternative to existing methods.

Intraocular lens exchange-removing the optic intact

Current practice for intraocular lens (IOL) exchange is to cut the optic of the posterior chamber intraocular lens (PCIOL) prior to removing it. Great care must be taken during this maneuver to avoid a posterior capsular tear. Removing the haptics from the fibrosed capsule can also be hazardous, as it may result in zonular stress and dehiscence. A technique is described for performing foldable (one-piece acrylic) IOL removal without cutting the optic. Careful visco-dissection of the haptics with a low viscosity ophthalmic viscosurgical device (OVD) in the fibrosed peripheral capsular tunnel avoids zonular or capsular stress. Internal wound enlargement permits foldable IOL removal in one piece, whilst preserving a self-sealing sutureless corneal wound. This technique may enhance the safety and efficacy of foldable IOL exchange.