Intraocular lens explantation or exchange: indications, postoperative interventions, and outcomes

ABSTRACT Purpose: To analyze the indications for explantation or exchange of intraocular lenses (IOLs), which were originally implanted for the correction of aphakia during cataract extraction. Methods: All cases that involved intraocular lens explantation or exchange in one institution between January 2008 and December 2014 were analyzed retrospectively. Results: In total, 93 eyes of 93 patients were analyzed. The median time interval between implantation and explantation of the anterior chamber intraocular lenses (AC IOL) and posterior chamber intraocular lenses (PC IOL) was 83.40 ± 83.14 months (range: 1-276 months) and 55.14 ± 39.25 months (range: 1-168 months), respectively. Pseudophakic bullous keratopathy (17 eyes, 38.6%) and persistent iritis (12 eyes, 27.8%) in the AC IOL group and dislocation or decentration (30 eyes, 61.2%) and incorrect IOL power (nine eyes, 18.4%) in the PC IOL group were the most common indications for explantation of IOLs. The mean logMAR best corrected visual acuity (BCVA) improved significantly from 1.30 preoperatively to 0.62 postoperatively in the PC IOL group (p<0.001) but did not improve significantly in the AC IOL group (p=0.186). Conclusions: The primary indication for IOL explantation or exchange was pseudophakic bullous keratopathy in the AC IOL group and was dislocation or decentration in the PC IOL group. PC IOL explantation or exchange is safe and improves visual acuity.

【摘要】研究目的：分析因白内障摘除术中矫正无晶状体眼而植入的人工晶状体（intraocular lenses, IOLs）取出或置换的适应证。方法：回顾性分析2008年1月至2014年12月间，某机构内所有涉及人工晶状体取出或置换的病例。结果：共纳入93例患者的93只眼进行分析。前房人工晶状体（anterior chamber intraocular lenses, AC IOL）组与后房人工晶状体（posterior chamber intraocular lenses, PC IOL）组的植入至取出中位时间间隔分别为83.40±83.14个月（范围：1~276个月）与55.14±39.25个月（范围：1~168个月）。AC IOL组最常见的人工晶状体取出适应证为假性大疱性角膜病变（17只眼，占38.6%）与持续性虹膜炎（12只眼，占27.8%）；PC IOL组则为人工晶状体移位或偏心（30只眼，占61.2%）与人工晶状体度数不准确（9只眼，占18.4%）。PC IOL组患者的平均对数最小分辨角最佳矫正视力（logMAR best corrected visual acuity, BCVA）从术前的1.30显著提升至术后的0.62（P<0.001），而AC IOL组视力提升无统计学意义（P=0.186）。结论：AC IOL组人工晶状体取出或置换的首要适应证为假性大疱性角膜病变，PC IOL组则为人工晶状体移位或偏心。后房人工晶状体取出或置换手术安全有效，可改善患者视力。