Trends and Outcomes of Secondary Intraocular Lens Utilization Among Vitreoretinal Surgeons Compared to Vitreoretinal and Anterior Segment Surgeons.

Abstract

Background and objective: Scleral-fixated intraocular lens (SFIOL), scleral-sutured IOL (SSIOL), anterior chamber IOL (ACIOL) are used to manage aphakia or lens subluxation. This study compared trends in surgical techniques and outcomes of secondary IOL implantation based on surgeon type.

Patients and methods: This retrospective study included patients from United States (US) retinal centers who underwent surgery by vitreoretinal (VR cohort) or VR and anterior segment (AS) (combined cohort) surgeons from 2015 to 2024. Complications assessed included retinal detachment, endophthalmitis, suture erosion, haptic erosion, repeat pas plana vitrectomy, and corneal edema.

Results: VR surgeons performed 4,143 secondary IOL surgeries (1,977 ACIOL, 1,327 SFIOL, 839 SSIOL) while VR and AS surgeons performed 511 (342 ACIOL, 125 SFIOL, 44 SSIOL). SFIOL and SSIOL surgeries by VR surgeons increased, whereas ACIOL surgeries decreased. VR and AS surgeons maintained a steady but lower volume of SFIOL and SSIOL cases, with increasing ACIOL surgeries. Postoperative visual acuity for the VR and combination cohorts was 54.3 ± 27.8 and 51.5 ± 27.2 (≈ 20/100 Snellen) (P value = 0.102), respectively. Complication rates were similar between cohorts, except for postoperative retinal detachment (VR: 144, 3.5%; combined: 26, 5.1%; P value < 0.001).

Conclusion: ACIOLs were the most commonly performed secondary IOL surgery. However, a shift toward SFIOL and SSIOL techniques among vitreo-retinal surgeons emerged. Outcomes were comparable between approaches.