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.