Population-based analysis of intraocular lens exchange and repositioning

Abstract

Purpose To determine the incidence and trends in intraocular lens (IOL) repositioning, exchange, and explantation. Setting Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada. Design Population-based retrospective data analysis. Methods Service claims from 2000 to 2013 were analyzed for the total yearly number of IOL repositionings, exchanges, and explantations in Ontario, Canada, including the number of surgeons performing them by subspecialty. The 5-year incidence proportion of secondary IOL surgery for patients who had cataract surgery in 2000 and 2009 was calculated and then stratified by sex, age, and year of second surgery. Results Of the 1252 secondary procedures performed in 2013 (75.6% increase from 2000), 43.2% were repositionings without suturing, 31.6% were exchanges without suturing, 10.5% were sutured repositionings, 7.0% were sutured exchanges, and 7.7% were explantations. The incidence proportion of risk for secondary IOL surgery was 0.93% from 2000 to 2004, which decreased to 0.78% from 2009 to 2013 (16.4% decrease; odds ratio, 0.83; 95% confidence interval [CI], 0.72-0.94; P < .001). Patients who had these procedures were 1.56 times more likely to be men (95% CI, 1.39-1.76; P < .001) and 1.52 times more likely to be younger than 65 years (95% CI, 1.33-1.73; P < .001). From 2000 to 2013, sutured repositionings and explantations increased by 568% and 531%, respectively, whereas exchanges without suturing decreased by 22.6%. In 2013, 11.6% of surgeons performed 52.0% of all secondary IOL surgeries. Conclusions Although the absolute number of secondary IOL procedures increased from 2000 to 2013, the 5-year risk for surgery decreased. A large proportion of the surgeries was performed by a small number of surgeons, which suggests subspecialization.