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What are secondary intraocular lenses?
Secondary intraocular lenses refer to a rescue operation that we perform following a complicated cataract surgery or if a standard intraocular lens becomes dislocated. While as retina specialists we do not typically perform cataract surgery, we routinely perform these rescue operations. They are delicate and sophisticated operations that often involve a vitrectomy. There are several techniques that are employed, all with a high success rate. The pros and cons of each procedure should be thoroughly discussed with your surgeon.
How are secondary intraocular lenses performed?
It depends upon the indication for surgery and the procedure being performed, but is always a surgical procedure. If the lens is dislocated into the back of the eye, a vitrectomy will need to be performed. Some intraocular lenses can be retrieved from the back of the eye and fixated in place back where it belongs at the front of the eye. These are typically what we call three-piece intraocular lenses, where there is a single central circle of plastic with thin arms that come off in an arc on either side. Using what a modified Yamane technique, these thin arms are externalized through the sclera on either side of the eye at the appropriate location near the front of the eye. The ends of the arms are slightly melted to create small bulbs, which prevent the lens from moving. This is an elegant technique that we perform regularly and typically results in excellent vision with no large wounds in the eye.
If the lens cannot be fixated like this it will need to be removed from the eye by cutting it and removing it through a small wound at the front of the eye, typically through the cornea. Once the old lens is removed, the surgeon can either place a lens in front of the pupil, called an anterior-chamber intraocular lens, or they can fixate a new lens to the sclera behind the pupil using a very sophisticated technique that involves a special lens and Gore-tex suture. Both techniques have excellent outcomes.
How will my vision be with the intraocular lens?
Your vision should be excellent with the new lens, similar to what you had before the lens dislocated. You may, however, need a new or updated glasses prescription as the position of the new lens is less predictable than with standard cataract surgery.
Will the intraocular lens need to be removed?
No, the new lens should never need to be removed. There are rare cases where the new lens can become malpositioned, dislocated, or cloudy, which may require another surgery to correct.