Workshop 15

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The IOL Didn’t Last:   Indications and Tips for IOL Removal, Repositioning, and Exchange

Erick D. Bothun, MD; David Morrison, MD; Faruk Orge, MD; David A. Plager, MD; M. Edward Wilson
Mayo Clinic
Rochester, Minnesota

Purpose/Relevance: Pediatric cataract surgeons hope that intraocular lenses (IOLs), once implanted, will meet the refractive needs of the patient and stay well centered and optically clear for many years. However, the IOLs we’ve counted on lasting a lifetime may opacify, decenter, or become an optical hindrance. Additionally, as the age of primary implantation shrunk, the number of severe myopes from overpowered IOLs in our practices has dramatically expanded.  Lastly, piggyback IOL implantation strategies include a planned removal of one of the IOLs after the eye has grown. For all these reasons, the frequency of IOL removal, repositioning, and exchange has meaningfully increased in our practices.  A discussion of the indications, challenges, options and tips for such IOL re-operations is warranted.

Target Audience: Pediatric Ophthalmologists

Current Practice: Pediatric cataract surgeons are re-operating on IOLs that decenter, lose optical clarity or contribute to high myopia. The use of piggyback IOLs with planned later removal of one IOL is being performed more commonly. Most of the reports on the frequency of such challenges is found in the adult refractive and cataract literature and under-reported for children.  This panel includes pediatric cataract surgeons with experience and expertise in managing such IOL challenges.

Best Practice: Clinical and surgical management with high level evidence.

Expected Outcomes: Attendees will understand the limits of existing knowledge in long term IOL stability and will be prepared to surgically manage piggyback, subluxated, and opacified IOLs.

Format: Panel presentations and discussion of IOL removal and exchange including literature review, perspectives on patient care and surgical videos.

Summary: 1.   We will discuss the indications for IOL removal, exchange, or repositioning including literature review.
2.         Surgical management of IOL related high myopia and piggyback lenses will be explained.
3.         Videos will be displayed with surgical advice and tips including techniques and instrumentation.

References: 1. Causes of intraocular lens opacification or dislocation.  J Cat Refract Surg. 2007 Apr;33(4):713-26.
2.  Hanging by a thread:  The long-term efficacy and safety of scleral sutured intraocular lenses in children (An Am Ophthalmol Soc thesis).  Buckley EG.  Trans Am Ophthalmol Soc 2007.
3.  Long term endotheial cell loss after traumatic dislocation and repositioning of Artisan phakic IOL.  J Refrac Surg. 2008;May 24(5):546-8.

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