IOL Exchange

[blake9950]

I had a cataract removed from my left eye on August 14, implanted with Alcon AcrySof IQ (SN60WF) 14.5 D, and ended up hyperopic (+1.00 D). Right eye has no cataract and is myopic (-2.25 D). The power difference causes some peripheral double vision when wearing glasses. Also, left eye should not be hyperopic because it is my non-dominant eye. YAG treatment has not been necessary. I am 57 years old. I prefer to avoid piggyback lens and Lasik options, but was considering IOL exchange.

1. Is IOL exchange extraordinarily risky compared to benefits that could be achieved? What serious complications could happen? Is risk of retinal detachment higher than for original surgery?
2. Would it be harder to get proper centration and alignment of the replacement IOL, compared to the original?
3. I have no astigmatism now. Could the IOL exchange operation produce astigmatism?
4. Can my regular eye surgeon do this procedure safely, or do I need to find someone with special expertise?
5. If I have to locate another surgeon, is it critical to act fast? Could I delay IOL exchange up to a year since original implant?

I am very anxious about this, and will be grateful for any information you can provide.

[John C Hagan III, MD, FACS]

1. Piggy back IOL would be less risky than IOL exchange. Complications include infection, bleeding, tearing the posterior capsule, vitreous loss, retinal detachment and rarely inability to insert a second IOL. RD risks would probably be the same if the IOL can be exchanged without capsular tear and vitreous loss.
2. Yes
3. yes
4. Ask him. Some have done it a lot, some infrequently, some never. Obivously the latter might not be a good choice.
5. No further delay should not jeoporzide success.

6. other options would include hyperoic LASIK,  conductive keratoplasty.

JCH III MD

[blake9950]

Many thanks for your prompt and helpful answers. It sounds like the risks of IOL exchange may not be worth the potential benefits. I will explore the other options you mentioned.

[John C Hagan III, MD, FACS]

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