IOL exchange is surgery to remove an existing intraocular lens and replace it with a different one. It is considered when the current lens causes significant problems.
Reasons for Exchange
Indications include incorrect power leading to unacceptable refractive error, lens malposition, opacification of the IOL material, or intolerance to optical phenomena from multifocal or other premium lenses. Trauma or damage to the capsule may also necessitate change.
- The procedure is technically more challenging than primary cataract surgery
- The surgeon may place the new lens in the capsule, sulcus, or fixate it to the sclera or iris
- Vitrectomy is sometimes required if the old lens has shifted backwards
- Risks include capsule rupture, corneal decompensation, and retinal detachment
Planning and Recovery
Thorough assessment, including biometry, imaging, and discussion of alternatives, is vital before proceeding. Recovery is similar to cataract surgery but may be slower in complex cases.
- Alternative options such as glasses, contact lenses, or corneal laser may be safer in some situations
- Post-operative monitoring focuses on inflammation, pressure, and macular status
- Patients should have realistic expectations about achievable vision
- Once successful, exchange can significantly improve quality of life
