Rates and causes of intraoperative removal of foldable and rigid intraocular lenses: clinicopathological analysis of 100 cases.

Purpose: To analyze the rates of and reasons for intraoperative explantation of foldable and rigid intraocular lenses (IOLs) to determine the complication profile of each IOL design.

Setting: Center for Research on Ocular Therapeutics and Biodevices, Storm Eye Institute, Medical University of South Carolina, Charleston, South Carolina, USA.

Methods: The study comprised data analysis of foldable (n = 85) and rigid (n = 15) IOL specimens that were explanted immediately after primary implantation.

Results: Eighty-five foldable intraoperative explants were accessioned. These comprised 14.5% of the 586 foldable IOL explants received between January 1988 and September 2000. There were 15 rigid poly(methyl methacrylate) (PMMA) intraoperative explants out of 2077 rigid explant specimens (0.7%). Fifty-one (60%) of the foldable IOLs requiring intraoperative explantation were the 1-piece silicone plate-haptic large-hole design, and 29 (34.1%) were the 3-piece silicone polyimide-haptic design. The most frequent reason for explantation of both designs was optic damage, 37.3% in the large-hole design and 55.2% in the polyimide design. Optic damage did not occur in rigid PMMA IOLs.

Conclusion: Some foldable IOL designs have a higher risk of damage during surgical insertion than rigid designs. Two modern foldable IOLs, the silicone plate-haptic large-hole and the silicone polyimide-haptic, appear to be more prone to damage during folding, loading, and implantation than other IOLs.