Reasons for problems
When it comes to a reason why dislocation/decentration is the common complication overall, Dr. Mamalis explained that in most cases, the reason can’t be blamed on the IOL. He cited surgical technique or complications.
These often occur in cases where the capsulotomies were not completely intact anteriorly, Dr. Mamalis pointed out. Or the lens may not have been totally in the capsular bag, So the onus is on the surgeon rather than on the IOL.
To avoid complications with foldable IOLs, good surgical technique is essential, Dr. Mamalis said. The implant needs to be completely within the capsular bag, which will decrease the dislocation problem.
Accurate IOL measurements are important so the lenses are not removed because of incorrect lens power.
Glare and optical aberrations are occurring more as reasons for removal of multifocal lenses. Incorrect lens power still is surfacing on occasion. Even though methods of calculating IOL power have improved over the last 18 years of the survey, it still is the third most common reason for IOL explantation.
The numbers of explanted multifocal IOLs are increasing, Dr. Mamalis said. Surgeons are using more of them, so there are more potential complications that cause removal. Hydrophilic acrylic lens removals are declining, as are the silicone plate lenses, because in the United States, they are not being used as often as in the past.
Proper patient selection also is important for multifocal lenses to avoid the reasons for those lenses being explanted, he added.
Explantation of accommodating lenses are beginning to appear in the survey results, but the numbers are small to make any conclusions.