To report the indications, techniques, visual and refractive outcome and complications of secondary intraocular lens (IOL) implantation, exchange or revision in eyes with deficient capsular/zonular support.
Single centre audit at Kingston Hospital NHS Trust, London.
Indications, techniques, surgical details and visual and refractive outcome data were retrospectively collected for all eyes who underwent secondary IOL implant, revision or exchange between January 2014 and February 2020.
Thirty-six eyes (thirty-eight secondary IOL surgeries) of 35 patients were included. Average follow-up was 11.5±6months. The indications for IOL revision surgery were IOL dislocation/subluxation (24 eyes), aphakia (10 eyes) and IOL opacification (2 eyes); two eyes required two IOL revision surgeries (one ACIOL replaced with Artisan and one sulcus IOL replaced with Artisan). Of secondary IOLs, 20 were anterior chamber (12 angle supported and 8 iris-claw Artisan type) and 18 scleral fixated (12 scleral sutured and 6 fixated using Yamane technique). Final VA was 6/12 or better for 21/36 (58.3%) eyes. Thirty-one (86.1%) either gained or maintained pre-operative VA: 14/19 (73.7%) eyes having anterior chamber IOL and 15/18 (83.3%) with scleral fixated IOL. Mean post-operative spherical equivalent was -0.36±1.06D and mean astigmatism -1.95±2.00D. Ten eyes (28%) developed post-operative cystoid macular oedema, three eyes vitreous haemorrhage, one eye developed corneal oedema, and 3 had post-operative high intra-ocular pressure.
Scleral-fixated secondary intraocular lenses are a safe option for the management of IOL dislocation or aphakia in eyes lacking capsular/zonular support. In our series the visual outcomes were better than for anterior chamber IOLs.
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