Dvivedi Arundhati, Murthy Somasheila I, Manga Sukesh
Department of Cataract, LV Prasad Eye Institute, Kallam Anji Reddy Campus, Hyderabad 500034, Telangana, India.
Shantilal Shanghvi Cornea Institute, LV Prasad Eye Institute, Kallam Anji Reddy Campus, Hyderabad 500034, Telangana, India.
Int J Ophthalmol. 2024 Nov 18;17(11):2031-2036. doi: 10.18240/ijo.2024.11.08. eCollection 2024.
To report incidence, indications, and visual outcomes of intraocular lens (IOL) exchange/explantation surgery.
Retrospective analysis of 60 eyes requiring IOL exchange/explantation surgery between 1 January 2017 and 31 December 2022. The overall outcomes as well as comparison between the trainee versus experienced surgeons were analyzed.
Out of 39 778 cataract surgeries (with no preexisting ocular co-morbidities) during a six-year period (2017-2022), 60 (0.15%) needed IOL exchange/explantation. Surgeons-under-training performed 36/60 cases (60%) while 24/60 (40%) were by experienced surgeons. The commonest indication was subluxated IOL in 26 (43.3%), followed by dislocated IOL in 20 (33.3%), postoperative refractive surprise in 7 (11.6%), IOL induced uveitis in five and broken haptic in two eyes. Twenty-four (40%) eyes had intraoperative complications during primary surgery. Posterior chamber IOL (PCIOL) was the commonest secondary IOL in 21 (35%) eyes, scleral fixated in 20 (31.6%), anterior chamber IOL (ACIOL) in 13 (21.6%), iris fixated IOL in three (5%) and three eyes (5%) were left aphakic. The mean time between primary and secondary surgery was 168d (168±338.8). Best corrected visual acuity (BCVA) of >20/60 was obtained in 43 eyes (71.66%), 20/80-20/200 in 14 (23.33%), 20/250 in two and hand movements in one. No statistically significant difference in visual outcome was noted at post-op one month between trainees versus experienced surgeons (UCVA 0.45±0.29 0.53±0.32, =0.20, BCVA 0.34±0.25 0.37±0.26, =0.69).
IOL subluxation as the commonest indication and posterior capsular rupture is the commonest intraoperative risk factor. This complication can be effectively addressed with selection of the appropriate secondary IOL achieving good visual outcomes in over 70% of patients.
报告人工晶状体（IOL）置换/取出手术的发生率、适应证及视力预后。
回顾性分析2017年1月1日至2022年12月31日期间60例需要进行IOL置换/取出手术的患眼。分析总体预后以及实习医生与经验丰富医生之间的比较情况。
在六年期间（2017 - 2022年）的39778例白内障手术（无既往眼部合并症）中，60例（0.15%）需要IOL置换/取出。实习医生完成36/60例（60%），而经验丰富的医生完成24/60例（40%）。最常见的适应证是人工晶状体半脱位26例（43.3%），其次是人工晶状体脱位20例（33.3%），术后屈光意外7例（11.6%），人工晶状体诱导性葡萄膜炎5例，以及两只眼的襻断裂。24例（40%）患眼在初次手术时有术中并发症。后房型人工晶状体（PCIOL）是21例（35%）患眼中最常见的二期人工晶状体，20例（31.6%）采用巩膜固定，13例（21.6%）采用前房型人工晶状体（ACIOL），3例（5%）采用虹膜固定人工晶状体，3例（5%）眼保持无晶状体状态。初次手术与二次手术之间的平均时间为168天（168±338.8）。43例（71.66%）患眼的最佳矫正视力（BCVA）>20/60，14例（23.33%）为20/80 - 20/200，2例为20/二百五十，1例为手动视力。术后1个月时，实习医生与经验丰富医生之间的视力预后无统计学显著差异（裸眼视力0.45±0.29对0.53±0.32，P = 0.20；BCVA 0.34±0.25对0.37±0.26，P = 0.69）。
人工晶状体半脱位是最常见的适应证，后囊膜破裂是最常见的术中危险因素。通过选择合适的二期人工晶状体，这种并发症可以得到有效处理，超过70%的患者可获得良好的视力预后。
