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    Adjustable intraocular lenses after cataract surgery

    Take-home: IOL exchange following cataract surgery can be difficult and lead to complications. Piggyback IOLs, light-adjustable lenses and multicomponent IOLs offer different options for the correction of residual refractive errors.

    Cataract surgery is considered very effective for the restoration of precise visual acuity. The refinement of current surgical techniques, paired with technological advancements in IOL design and biometry methodology, has increased the accuracy of IOL power calculations, minimising refractive surprises following cataract surgery. 

    Nevertheless, it has been established that no cataract or refractive surgery will ever be 100% accurate due to errors in biometry, pre-existing or induced astigmatism, previous corneal refractive surgery, effective lens position and variables associated with wound healing.1 Most clinical studies report mean errors in IOL power calculation of approximately 0.50 D, with a standard deviation of 0.50 D or higher. Errors higher than 3 D are extremely rare but do occur,1–5 especially post refractive surgery.

    In this latter subgroup of patients, despite the use of special formulas for the IOL calculation,6 residual refractive errors are a frequent occurrence. In general, refractive surprises after cataract surgery can compromise an otherwise successful result by creating unsatisfactory visual acuity outcomes and can create situations that are difficult to handle for both patient and physician.

    Corneal-based procedures (laser refractive surgery) and lens-based procedures are commonly used in order to resolve the issue of poor refractive results following cataract surgery. However, corneal refractive surgery has several limitations: it is not suitable for high refractive errors and requires access to an Excimer laser, which may not always be available.

    Additionally, patient acceptance of new IOLs (e.g., multifocal) may require lens exchange where laser procedures would not be helpful. Finally, dry eye symptoms can be created/exacerbated with corneal laser surgery, creating yet another challenge for both patient and physician. These problems are easily solved with multicomponent or piggyback IOLs.

    Lens-based procedures include IOL exchange, piggyback IOLs, light-adjustable lenses and multicomponent IOLs. 

    Lens-based procedures

    Dimitra M. Portaliou
    Dimitra M. Portaliou, MD, practices at the University of Crete, School of Health Sciences, Institute of Vision and Optics, in Crete, Greece.

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