ASCRS/ESCRS survey: Dislocation, decentration top reasons for foldable IOL explantation

Lisbon, Portugal - The results of the 7th annual survey on foldable IOLs indicate that dislocation and decentration are by far the most common reasons for lens explantation, with incorrect lens power the next most important factor. Nick Mamalis, MD, reported the results of the survey - conducted by the American Society of Cataract and Refractive Surgery (ASCRS) and the European Society of Cataract and Refractive Surgeons (ESCRS) - Monday morning at ESCRS’ annual meeting.

The survey questionnaire considered the patient signs and symptoms; type of IOL that was removed; preoperative and postoperative visual acuity; and patient symptoms requiring removal. The IOLs considered were the one-piece plate type, one-piece IOLs with haptics, three-piece IOLs, and foldable IOLs. The IOL materials were silicone, hydrophilic, hydrophobic, and acrylic.

The most common symptoms that precipitated removal of three-piece silicone IOLs were (in descending order): dislocation, decentration, incorrect lens power, glare, and optical aberrations; for the plate silicone IOLs: dislocation and decentration; for three-piece hydrophobic acrylic IOLs: dislocation, decentration, incorrect lens power, glare, and optical aberrations; for one-piece hydrophobic acrylic IOLs with haptics: decentration, dislocation, and incorrect lens power; for hydrophilic acrylic, and one-piece IOLs: calcification; and for multifocal silicone IOLs: glare and optical aberrations, Dr. Mamalis reported. He is from the John A. Moran Eye Center, University of Utah, Salt Lake City, United States. The visual acuity levels were relatively good with all types of IOLs.

“Calcification in this survey applied exclusively to hydrophobic acrylic IOLs on the surface and the substance of the lens itself. Glare and optical aberration were seen with all types of lenses,” Dr. Mamalis said.

“The best way to avoid explantation of IOLs is to adhere to excellent surgical technique. Work on insertion techniques should decrease the problems with decentration and dislocation,” Dr. Mamalis added. “Work is ongoing on technologies for more accurate measurement to choose the IOL power. We need ongoing vigilance about new IOL materials as they are developed.”