Surgical implications in intraocular lens exchange with an open posterior capsule: a retrospective case series and review of the literature.

Abstract

Purpose: To determine characteristics and differences in intraocular lens (IOL) exchange between eyes with an open (OPC) and closed posterior capsule (CPC).

Setting: Department of Ophthalmology, Goethe-University, Frankfurt, Germany.

Design: Retrospective case series and review of literature.

Methods: Charts of all cases of IOL exchange between January 2010 and May 2024 were retrospectively reviewed. Main outcome measures were indications for surgery, IOL implantation technique, and the necessity of anterior vitrectomy. MEDLINE database and Google scholar were used to identify relevant past publications.

Results: We included 37 eyes of 30 patients with a mean age of 62.1 ± 10.2 years, with 16 eyes (43.2%) with OPC undergoing IOL exchange. Mean interval between IOL implantation and IOL exchange was 61.50 ± 62.00 months in the OPC group and 15.81 ± 15.03 months in the CPC group. The most common indication was optical phenomena in 18 cases (48%). In the OPC group, intraoperative anterior vitrectomy was necessary twice as often (OPC nine cases (56%) vs. CPC five cases (24%)). Bag-to-bag IOL exchange was performed in all eyes with CPC, and in 10/16 (62%) with OPC (p=0.009). Postoperative complications were seen in a total of 7/16 eyes (43.7%) with OPC and 3/21 (14.3%) with CPC (p=0.012).

Conclusion: The success rate of repositioning an IOL within a bag with OPC is less than that achieved with CPC. A vitrectomy is typically required when attempting a bag-to-bag IOL exchange with an OPC. Capsulotomy should only be performed if the necessity of an IOL exchange is unlikely.