Changing indications for intraocular lens removal

Objective: To evaluate the effect of progress made in cataract surgery techniques on indications and results of intraocular lens (IOL) removal. Patients and mrthods: The charts of all patients who underwent IOL explantation at our institution between January 1990 and December 1992 were reviewed. Data recorded included patients' age and sex, time interval from implantation to removal, indication for IOL explantation, type of IOL removed, best-corrected visual acuity before and after explantation, and length of follow-up after removal. Indications were divided into six groups: (a) chronic, low-grade endophthalmitis; (b) pseudophakic bullous keratopathy; (c) luxation; (d) traumatic expulsion; (e) high-degree anisometropia; (f) acute endophthalmitis. Visual acuities were grouped according to good (20/20 to 20/40), acceptable (20/50 to 20/400), or poor (less than 20/400) outcome. Results: Fifty-two IOLs were removed from 52 eyes of 52 patients over the period of time considered in this study. Sixteen were anterior chamber IOLs, five were iris-fixated IOLs, and 31 were posterior chamber IOLs. Sixteen (30.8%) IOLs were removed for chronic, low-grade endophthalmitis, 15 (28,8%) for bullous keratopathy, 15 (28.8%) for luxation, three (5.8%) for traumatic expulsion, two (3.8%) for high-degree aniseikonia, and one (1.9%) for acute endophthalmitis. After explantation, vision equal to or better than 20/400 could be achieved by the vast majority of patients of all groups excepted for those with bullous keratopathy. Conclusion: The progress made in cataract surgery techniques over the last decade has greatly influenced the relative frequency of different reasons for IOL removal. Continuous monitoring of explanted IOLs is mandatory to evaluate further changes in surgical techniques and lens design.