Surgical and visual outcomes following exchange of opacified Hydroview® intraocular lenses

Aim: To report the clinical and surgical outcomes following exchange of opacified Hydroview((R)) intraocular lenses (IOLs), and to relate the final visual and anatomic results to clinical and surgical variables. Methods: This is a prospective study of seventy-three eyes that underwent exchange of opacified Hydroview((R)) IOLs in Waterford Regional Hospital, Ireland. Preoperative, intraoperative and postoperative details were recorded. Results: This study comprised 73 eyes of 71 consecutive patients undergoing IOL exchange, performed at mean (+/- SD) intervals of 36.64 (+/- 9.9) months following the primary cataract surgery. The mean (+/- SE) follow-up following the exchange procedure was 13 (+/- 1) months (range: 1 45 months). The secondary IOL was placed in the capsular bag, in the sulcus, and in the anterior chamber in 22 (30.1%), 24 (32.9%) and 27 (37%) cases, respectively. The IOL exchange procedure was uneventful in 36 eyes (49.3%), whereas intraoperative events such as posterior capsule rupture, vitreous loss and zonular dehiscence were seen in the remainder (50.7%). Following the IOL exchange procedure, a significant improvement in best corrected visual acuity (BCVA) was noted at one and at three months, and at the final visit (Wilcoxon signed ranks test: p < 0.001, p=0.006, and p < 0.001, respectively). Following exclusion of eyes with visually consequential ocular comorbidity, a better final BCVA was noted among those eyes where the secondary IOL was placed in the capsular bag or in the sulcus when compared with placement of the secondary IOL in the anterior chamber (IOL in the bag or sulcus: 26 eyes (35.6%), median (IQR) final BCVA: 0.2 (0.10-0.40); IOL in the anterior chamber: 19 eyes (26.02%), median (IQR) final BCVA: 0.5 (0.20-0.60); Mann Whitney U Test: p=0.004). Conclusion: IOL exchange is a technically challenging, but visually rewarding procedure. However, placement of the secondary IOL in the anterior chamber is associated with a poorer visual outcome when compared with placement of the secondary IOL in the sulcus or in the capsular bag.