Eyeworld

EW INTERNATIONAL 84 May 2017 Study explores trends in IOL explantation, exchange, and repositioning by Stefanie Petrou Binder, MD, EyeWorld Contributing Writer surgeries, from 2000 to 2013, with the exception of repositionings with suturing, which increased by 568% from 2000; exchanges with suturing, which increased by 531% from 2000; and exchanges without suturing, which decreased by 22.6% from 2000. Fewer surgeons in proportion The proportion of services billed by high-volume surgeons, performing ≥ 10 secondary IOL procedures per decreased to 0.78% from 2009 to 2013 (RR 0.83, 95% CI 0.72– 0.94, P<.001). From 2009 to 2013, patients receiving IOL repositioning or exchange were 1.56 times more likely to be male (95% CI 1.39– 1.76, P<.001) and 1.52 times more likely to be younger than 65 years of age (95% CI 1.33–1.73, P<.001). The study showed that the number of secondary IOL procedures remained stable per 10,000 cataract procedures carried out in Ontario's single payer, universal health care system, which includes patients from all institutions in the province. All patients who underwent cataract surgery from 2000 to 2013 were included, and patients requiring a secondary IOL procedure were then identified. The primary outcome measures included the 5-year incidence of patients requiring repositioning, explantation, and/or IOL exchange, as well as the number of IOL repo- sitionings, explantations, and/or exchanges relative to the number of cataract surgeries performed annual- ly. As a secondary outcome measure, Dr. Szigiato assessed the number of surgeons performing secondary IOL surgery by subspecialty. Rising numbers In 2013, repositionings without su- turing represented 43.2% (541 pro- cedures) of all procedures, exchanges without suturing 31.6% (395), repositionings with suturing 10.5% (132), exchanges with suturing 7% (88), and explantations 7.7% (96). Looking specifically at IOL ex- changes, several factors could have been responsible for the observed changes over the study period, such as the overall rise in precataract refractive surgery with its associated difficult IOL power calculations. 1 Other explanations for the increased number of IOL exchange surgeries, as revealed through previous clinical investigations, include the height- ened expectations for postoperative emmetropia, on the one hand, and the high feasibility of IOL exchange as an option for dissatisfied patients with persistent visual symptoms after refractive IOL placement, on the other. 2,3 Another contributing factor for the increase seen in IOL exchanges relates directly to height- ened surgical confidence in placing scleral-fixated posterior chamber IOLs, as was demonstrated in anoth- er recent study on practice patterns of cataract surgeons at academic medical centers. 4 According to Dr. Szigiato's observations, 61.3% of all exchang- es and 67.5% of all repositionings occurred in the same year as the original cataract surgery. The 5-year incidence, or risk, of a secondary IOL procedure after cataract surgery was 0.93% from 2000 to 2004 and Over a 13-year period, proportionately fewer patients need IOL follow-up operations today than they did in 2000, in spite of broadened indications for IOL exchange L ens exchange, explantation, and repositioning are used to manage complications or undesirable refractive out- comes in unsatisfied patients following cataract extraction with IOL implantation. In the past de- cade, indications for IOL exchange have expanded to include: unantici- pated refractive error, dissatisfaction with multifocal IOLs, and dyspho- topsia following cataract surgery. Understanding the incidence of secondary IOL procedures can offer important insights into the safety and efficacy achieved by cataract surgical techniques and devices amid the ever-increasing surgical numbers and patient demands. A population-based retrospec- tive cohort analysis of IOL ex- changes and repositioning found a decreasing incidence in secondary IOL procedures in Ontario, Canada, from 2000 to 2013. Although the number of secondary IOL proce- dures increased from 2000 to 2013, as did the overall number of sur- geons performing the procedures, the overall incidence of secondary surgeries was lower over the 13-year time span. According to the study's lead investigator Andrei-Alexandru Szigiato, MD, research fellow, Uni- versity of Toronto, Toronto, Canada, this may be attributed to improved outcomes in cataract surgery. Dr. Szigiato presented the study poster at the 2016 annual meeting of the American Academy of Ophthalmol- ogy in Chicago. Dr. Szigiato and the study team analyzed population-based claims from 2000 to 2013 for the yearly number of all secondary IOL Presentation spotlight Andrei-Alexandru Szigiato, MD Figure 1. Number of intraocular lens repositioning, lens exchange, and lens explantation procedures, with and without scleral fixation, performed in Ontario from 2000–2013. A: Trend of total number of procedures from 2000–2013. B: Trend of number of procedures per 10,000 cataract surgeries performed in the same year. Figure 2. Survival curves for eyes requiring secondary IOL procedures, relating time to repositioning or exchange by gender, age group, and year of cataract surgery. Source (all): Andrei-Alexandru Szigiato, MD

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