Surgical indications and outcomes of intraocular lens exchange surgery: A 5-year retrospective review

Objectives: Intraocular lens (IOL) exchange is performed to address complications or patient dissatisfaction after primary IOL implantation. We evaluated indications, surgical techniques, visual and refractive outcomes and complications after IOL exchange at Mass Eye and Ear (Boston, USA). Materials and Methods: This is a retrospective observational cohort study of adults undergoing IOL exchange by a single surgeon from January 2019 to December 2024. Variables obtained included indication for IOL exchange, explanted and implanted IOL type, fixation site, pre-operative and 1-month post-operative best-corrected visual acuity (BCVA), post-operative spherical equivalent error relative to target and any post-operative complications. Results: The cohort was comprised of 195 eyes (172 patients), with a mean age of 66.4 ± 10.6 years and a mean interval from cataract surgery to exchange of 6.6 ± 10.9 years. The leading indications were IOL dislocation (32.3%) and multifocal IOL intolerance (14.4%). Monofocal IOLs were most commonly explanted (51.3%) and implanted (93.8%), and the CT Lucia 602 (Zeiss, Oberkochen, Germany) lens type accounted for 34.3% of secondary implants. Secondary fixation was in the capsular bag (36.4%), ciliary sulcus (32.8%) or flanged intrascleral haptic fixation (28.2%). There was significant improvement in mean BCVA postoperatively with 71.3% of eyes achieving BCVA of 20/40 or better ( p = 0.04). Spherical equivalent was within ±0.50 D of the target in 86.5% of patients. Complications included cystoid macular oedema (7.2%), elevated intraocular pressure (4.6%) and retinal detachment (0.5%). Conclusion: IOL exchange produced significant early visual improvement and high refractive accuracy with rare complications in this large single-surgeon cohort.