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Klin Monbl Augenheilkd 2023; 240(04): 415-420
DOI: 10.1055/a-2004-5147
Klinische Studie

Indications, Complications, and Early Postoperative Course of Recovery of Intraocular Lens Exchange Surgery: a Single-Center Retrospective Study

Indikationen, Komplikationen und früher postoperativer Erholungsverlauf nach Intraokularlinsen-Austausch: Eine monozentrische retrospektive Studie
Marcio Silva
1   Ophthalmology, City Hospital Waid and Triemli, Zurich, Switzerland
2   Ophthalmology, Eye Center Wil, Wil, Switzerland
,
Selim Orguel
1   Ophthalmology, City Hospital Waid and Triemli, Zurich, Switzerland
3   Ophthalmology, University of Basel, Basel, Switzerland
,
Matthias Becker
1   Ophthalmology, City Hospital Waid and Triemli, Zurich, Switzerland
4   Ophthalmology, Heidelberg University, Heidelberg, Germany
,
Florentina Joyce Freiberg
1   Ophthalmology, City Hospital Waid and Triemli, Zurich, Switzerland
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Abstract

Purpose To analyze the indications, complications, and early course of recovery of intraocular lens (IOL) exchange surgery.

Material and Methods Records of patients who underwent IOL exchange during a 6-year period at a tertiary referral center were reviewed and the indications and complications after surgical intervention were analyzed. Their effects on postoperative corrected distance visual acuity (CDVA), intraocular pressure (IOP), use of IOP-lowering medications, and refractive cylindrical power were assessed.

Results One hundred and seventy-one eyes (165 patients) were investigated. The most frequent indication for IOL exchange was lens dislocation in 163 eyes (95.32%). The main causes of IOL dislocation were pseudoexfoliation syndrome (PEX) in 98 eyes (57.31%) and complications during cataract surgery in 40 eyes (23.39%). During IOL exchange, an anterior iris-claw fixation was performed in 159 eyes (92.98%). After significant initial deterioration to 1.59 ± 1.08 logMAR on postoperative day 1 (p ≤ 0.001), the CDVA recovered to preoperative levels within 28 days. A significant decrease in IOP was observed on postoperative day 1 (p = 0.04). The most common postoperative complications were corneal edema in 114 eyes (66.67%) and vitreous hemorrhage in 67 eyes (39.18%).

Conclusion The high early postoperative prevalence of corneal edema and intraocular hemorrhage was found to affect visual recovery after IOL exchange, causing a significant initial deterioration of CDVA and a delay of full visual recovery. These findings suggest that surgical approaches minimizing the risk of this type of complications should be favored.

Zusammenfassung

Hintergrund Ziel dieser Studie war es, eine große Kohorte an Intraokularlinsen-Austauschoperationen (IOL-Austausch) retrospektiv hinsichtlich der Indikationen für den Eingriff zu untersuchen und den Einfluss von postoperativen Komplikationen auf den frühen Erholungsverlauf zu beurteilen.

Material und Methoden Untersucht wurden IOL-Austauschoperationen an einem städtischen Krankenhaus während eines Zeitraums von 6 Jahren. Aus den medizinischen Akten wurden die Indikation, die Komplikationen, der prä- und postoperative Visus, Augendruck (IOP) und die refraktive Zylinderstärke sowie der Einsatz von drucksenkenden Medikamenten gesammelt.

Ergebnisse Es wurden insgesamt 171 Eingriffe (165 Patienten) untersucht. Die häufigste Indikation für einen IOL-Austausch war die IOL-Dislokation (163 Augen, 95,32%). Die häufigsten Gründe für eine IOL-Dislokation waren ein Pseudoexfoliationssyndrom (PEX) in 98 Augen (57,31%) und intraoperative Komplikationen während der Kataraktoperation in 40 Augen (23,39%). In 159 Augen (92,98%) wurde die neu implantierte Linse präpupillär an der Iris fixiert. Nach einer signifikanten anfänglichen Visusverschlechterung auf 1,59 ± 1,08 logMAR am ersten postoperativen Tag (p ≤ 0,001) erholten sich die Visuswerte innerhalb von 28 Tagen auf das präoperative Niveau. Am ersten postoperativen Tag zeigte sich eine signifikante Senkung des Augendrucks (p = 0,04). Die häufigsten postoperativen Komplikationen waren das Hornhautödem in 114 Augen (66,67%) und die Glaskörperblutung in 67 Augen (39,18%).

Schlussfolgerung Das häufige unmittelbar postoperative Auftreten von Hornhautödemen und intraokulären Blutungen führte zu einer signifikanten anfänglichen Visusverschlechterung und hatte somit Einfluss auf den frühen Erholungsverlauf nach IOL-Austausch. Diese Ergebnisse legen nahe, dass zur Vermeidung einer Verzögerung der vollständigen Visuserholung Operationsmethoden mit einem geringen Risiko solcher Komplikationen bevorzugt werden sollten.

Key words

cataract - intraocular lens exchange - IOL dislocation

Schlüsselwörter

Intraokularlinsen-Austausch - IOL-Dislokation - Katarakt


Publication History

Received: 19 September 2022

Accepted: 22 December 2022

Article published online:
25 April 2023

© 2023. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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