Ophthalmic Surg Lasers Imaging Retina. 2026 May;57(5):310-318. doi: 10.3928/23258160-20260320-01. Epub 2026 Apr 21.
ABSTRACT
BACKGROUND AND OBJECTIVE: This study reports outcomes of secondary intraocular lens (IOL) surgeries from a vitreoretinal service.
PATIENTS AND METHODS: A retrospective cohort study was performed of consecutive patients undergoing secondary IOL implantation between January 2017 and September 2024 by five vitreoretinal surgeons at a single tertiary academic center. Eyes were categorized by secondary IOL type: sulcus IOL, scleral fixated IOL (SFIOL, eg, Yamane technique), scleral sutured IOL (SSIOL, eg, Akreos lens), and anterior chamber IOL (ACIOL). Primary outcomes include intraoperatively identified retinal breaks and postoperative retinal detachments. Secondary outcomes include anesthesia type, case duration, and rates of lens repositioning or exchange due to rotation, dislocation, or other complication, endolaser for retinal tufts/tags, rescued IOL, iridotomy, combination silicone oil removal, air or gas used, and fibrin sealant use. Comparisons between categorical variables were made using the chi-square test of independence or the likelihood ratio if chi-square assumptions were not met. Comparisons between continuous variables were analyzed using Mann-Whitney U or Kruskal-Wallis ANOVA. Equal variances were not assumed. P values < .05 were considered statistically significant, with Bonferroni correction applied for multiple comparisons.
RESULTS: A total of 138 eyes from 136 patients were included in the study (42 ACIOL, 27 sulcus IOL, 43 SFIOL, 26 SSIOL). Retinal tears or holes were intraoperatively identified in nine (6.5%) eyes. Of those, two (1.4%) also had focal retinal detachments (RD). Retinal tags and other suspicious areas of retina were prophylactically lasered in nine (6.5%) cases, and 16 (11.6%) eyes received endolaser retinopexy. Postoperative RD occurred in three cases (2.2%). Eyes with a history of RD or PPV were associated with a lower rate of intraoperatively identified retinal breaks (P = .01 and 0.008, respectively). Rates of iridotomy differed significantly between IOL types (P < .001). ACIOLs were associated with worse vision at POM3 and higher rates of postoperative CME (P = .002). SSIOLs were associated with higher rates of vitreous hemorrhage (P < .001). Among SFIOL cases, three (7.0%) developed severe IOL rotation, and all required repeat IOL surgery.
CONCLUSIONS: Secondary IOL surgery performed by vitreoretinal surgeons was associated with a lower rate of intraoperative retinal breaks and postoperative RD compared to previous reports. There was a trend towards lower rates of intraoperatively identified retinal breaks in eyes with prior RD or PPV. Some IOL types were associated with higher rates of postoperative complications such as CME and vitreous hemorrhage.
PMID:42139587 | DOI:10.3928/23258160-20260320-01
