Intraocular Lens Exchange

Abstract

In patients with anticipated challenges to compliance with refractive amblyopia management after pediatric cataract surgery, primary intraocular lens (IOL) implantation after lensectomy has become the preferred alternative to aphakia ever since the Infant Aphakia Treatment Study (IATS) demonstrated that was an acceptable decision (The Infant Aphakia Treatment Study Group, JAMA Ophthalmol 132:676–682, 2014). However, there can be a variable degree of myopic shift after pseudophakia that can result in significant anisometropia while the child is still within amblyogenic age. As the focus in pediatric cataract surgery has shifted more toward optimizing refractive outcomes given advances in surgical technology, IOL exchange has become a widely accepted option for managing severe anisometropia and associated intolerable aniseikonia in pseudophakic children. Utilizing an illustrative case, the preoperative, intraoperative, and postoperative considerations for IOL exchange in pediatric cases are discussed in detail within this chapter. A step-by-step guide to extracting the primary IOL and implanting a new IOL (planned sulcus placement with optic capture) is explained.