Lens exchange to correct refractive errors is a safe and effective method

Tired of wearing glasses? Aside from refractive laser surgery, refractive lens exchange surgery is also a safe and effective technique.

woman wearing glasses while thinking

While refractive lens exchange is a valid option, in addition to laser refractive surgeries, not all are suitable candidates to receive this care. Consult with your ophthalmologist to learn more about this treatment.

Refractive lens exchange (RLE) surgery is a technique used to correct refractive errors. Because it involves the replacement of the natural crystalline lens of the eye, it is more surgically invasive and can result in adverse events that may be more disabling. Although it has been reported that RLE done in eyes with high axial lengths have a greater risk of adverse events, there have been very few studies done on the risks of RLE in the general population. It is important that this kind of research be done because, in general, RLE patients are younger, have softer lenses, and have less co-morbidities.

In this retrospective study, all of the intraoperative and postoperative adverse events (AE) of patients who came in for primary RLE over a span of 2 years (2014-2016) were collected. All had either clear lens extraction, with either no cataract or had only mild lens changes and a corrected visual acuity (CDVA) not worse than 20/40), and therefore underwent surgery for correction of refractive errors. z

A total of 18,689 eyes of 10,206 patients were evaluated; 1,164 (6%) eyes had AEs, and 171 eyes (0.9%) had serious adverse events (SAEs). It was also found that 98.2% of eyes with adverse events afterwards had a binocular uncorrected distance visual acuity (UDVA) of 20/40 or better, regardless of pre-operative uncorrected visual acuity. In addition, the manifest spherical equivalent on the last postoperative visit was within 0.50 diopters (D) in 74.2% of eyes treated. The most common AE was the development of posterior capsule opacification (PCO, incidence of 4.0%).

Meanwhile, in the cohort of patients without any AEs and who had a preoperative CDVA of 20/20 or better, 94.8% achieved a postoperative CDVA of 20/20 or better, with 89.1% of patients having a binocular UDVA of 20/20 or better. The most common SAE was cystoid macular edema, which occurred in 54 eyes (0.29%). Other macular pathologies constituted SAEs. Of all eyes with SAEs, regardless of the preoperative CDVA, 94% had binocular UDVA of 20/40 or better.

Only two patients in the study had a postoperative CDVA in the study that was less than 20/40 in each eye. These were both due to PCO, which improved with treatment. Intraoperative AEs were lower than the published rate between 1-2%, with the most common reported AE being capsular tear with or without vitreous loss.

Overall, this study found that refractive lens exchange surgery with modern surgical methods is safe and effective. Even with a complication rate of 6%, the AEs were minor, treatable, and did not affect the final outcome.

Schallhorn, J., Schallhorn, S., Teenan, D., Hannan, S., Pelouskova, M., & Venter, J. (2019). Incidence of intraoperative and early postoperative adverse events in a large cohort of consecutive refractive lens exchange procedures. American Journal of Ophthalmology. doi: 10.1016/j.ajo.2019.08.025

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