Preferred practice patterns survey of secondary intraocular lens implantation in Spain

Purpose To determine preferred practice patterns for secondary intraocular lens (IOL) implantation in the absence of capsular support among Spanish ophthalmologists. Methods Cross-sectional study based on an anonymous online survey conducted in Spain. A 31-item questionnaire was distributed to members of the Spanish Society of Cataract and Refractive Surgery (SECOIR) and the Spanish Retina and Vitreous Society (SERV). It collected data on demographics, preferred surgical techniques, techniques abandoned and reasons for discontinuation, and management of predefined clinical scenarios. Results A total of 210 ophthalmologists completed the survey. 29.2% of ophthalmologists younger than 40 years reported no training on this topic during residency. For the management of aphakia without capsular support, 69% preferred delaying secondary IOL placement, mainly to obtain specific instruments or IOLs (83.3%). Complete pars plana vitrectomy was the preferred vitreous management technique (61%). The preferred first-line techniques were retropupillary iris-claw IOL implantation (33.3%), T-shaped harpoon scleral-fixated IOL implantation (28.6%), prepupillary iris-claw IOL implantation (15.2%), and the Canabrava technique (8.6%). Angle-supported anterior chamber IOLs and the Yamane technique were each selected by 3.3% of respondents. Conclusions Retropupillary iris-claw IOL implantation was the preferred first-line option among Spanish ophthalmologists. Despite improved training among younger surgeons, nearly one third of ophthalmologists under 40 years still reported no formal training, suggesting persistent gaps in residency training.