IOL replacement: A retrospective long-term analysis to assess the reasons and the frequency of intraocular lens explantation

Purpose To assess the changing reasons and frequency of IOL explantation respectively replacement in a long-term setting Setting Eye clinic, Potsdam, Germany Design Monocentric retrospective observational case series Methods A retrospective analysis of all patients who underwent IOL explantation at our clinic between 1/2009 and 07/2025 was conducted. Opacified IOLs were examined using light microscopy, electron microscopy and energy-dispersive X-ray spectroscopy. Results A total of 244 IOLs were replaced in our clinic. At the time of explantation, patients were 72 years old on average (±15.41; min 2 years; max 96 years). The most common reason for explantation (60%) was dislocation or subluxation of the IOL, followed by IOL opacities (18%), corneal decompensation associated with anterior chamber lenses (9%), visual disturbance in the refractive IOL (4%), refractive error (4%), cataract development due to phakic IOL (4%) and Uveitis-Glaucoma-Hyphema Syndrome (1%). Over the years, there has been an increase in IOL explantations. For all reasons for explantation, the median interval between primary IOL implantation and IOL replacement was 54 month (IQR, 3.6-132 months). All opacified IOLs exhibited calcification. Secondarily implanted IOLs most commonly used iris fixation (57%), followed by sulcus fixation (22%), capsular bag fixation (17%) and scleral fixation (4%). Conclusion The most common reason seen for explantation was IOL dislocation, and the most common refixation site was the iris.