Explaining explantation in foldable IOLs

San Diego-Findings from a recent survey of surgeons tap the top reasons for why foldable IOL explantation occurs-whether in one- or three-piece silicone or one-piece acrylic lenses, said Nick Mamalis, MD.

By far, the leading cause of foldable IOL explantation is decentration and dislocation, said Dr. Mamalis, MD, speaking at the 2015 meeting of the American Society of Cataract and Refractive Surgery (ASCRS).

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The 17th annual survey of the ASCRS and the European Society of Cataract and Refractive Surgeons (ESCRS) was available to members throughout 2014. Surgeons filled out one form for each explanted foldable IOL.

Preoperative data was collected, as well as type of IOL requiring explantation. The patients’ signs and symptoms, as well as complications requiring explantation, were tabulated. Lastly, postoperative results were assessed.

“We separated out multifocal and accommodating lenses; it was difficult to make any general conclusions about accommodating lenses since we had such a small sample size,” said Dr. Mamalis, MD, who is in practice in Salt Lake City.

“While dislocation/decentration was the most common reason for explanting the three-piece silicone lens, we did see a couple of cases of calcification,” he said. “If you look at the one-piece hydrogel, hydrophilic, monofocal lens, we saw significant calcification in these lenses.”

Overall, Dr. Mamalis said, complications varied depending on the type of foldable IOL. Incorrect lens power and glare/optical aberrations were also noted in explantation of IOLs (the latter mostly in multifocal lens removal).

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The number of explanted multifocal IOLs increased over the past year, “but we’re implanting more of these lenses, too,” he said, so the numbers may seem more relevant than they may be.

Hinged plate haptic silicone lenses are starting to increase in number of explantation, but that may also be due to the number of lenses being implanted.

For now, the issues with “incorrect lens power I thought we had nipped in the bud, but it’s popped back up again,” he said.

The most common complications involving foldable IOLs have changed little over the past 5 years, he said.

“The way to avoid these explantation is to have excellent surgical techniques, quality manufacturing, careful IOL folding and insertion, and accurate IOL measurements,” Dr. Mamalis said.

Finally, as the Baby Boomer generation moves into needing cataract surgery, “it will become even more crucial to have accurate IOL measurements,” he said. “You will need to counsel your previous laser-vision-correction patients that their previous surgery makes IOL measurements more difficult.”