Dislocated Intraocular Lens (IOL)
What are Secondary Intraocular lenses (IOL)?
Secondary Intraocular Lenses (IOLs) are artificial lenses implanted in the eye when the natural lens or initial artificial lens is unable to function properly (such as a dislocation or causing intolerable side effects). They are typically used in cases where a primary cataract surgery has been performed, but complications arise later that require additional intervention.
Why might I need a Secondary IOL?
You might need a Secondary IOL if you experience complications following cataract surgery, such as dislocation of the original lens, incorrect lens power, or intolerable side effects from the initial lens (such as haloes or glare).
I like to describe the original lens in your eye (prior to primary cataract surgery) like a trampoline with springs. The “springs” in your eye are what keeps the original lens AND your subsequent IOL from your primary cataract surgery secure. Sometimes however, these springs are weak or broken in certain areas. Reasons include – prior trauma, certain genetic conditions (such as Marfan syndrome), PXF which is more common amongst certain ethnic groups and advanced age.
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Because these “springs” can no longer reliably hold any lens or IOL, other techniques have to be employed to secure it. My preferred technique is called a “sutured scleral-fixated IOL”.
The lens or IOL in your eye is supported by "springs" which are arranged in a very similar configuration to trampoline springs
What is a sutured scleral-fixated IOL?
This is a very reliable technique where I use special sutures to secure the IOL to the wall of the eye, called the sclera. This allows for a well-placed and centred IOL which is very stable and is unlikely to move out of place. Despite being a less common procedure, with only a few surgeons who specialise in this, I am well-versed and very comfortable performing this intricate procedure, having done about a hundred of these cases during my fellowships.
Will I still need glasses after Secondary IOL implantation?
The goal of Secondary IOL implantation is to improve your vision, but it is likely you will still require glasses for activities requiring fine detail, such as reading or driving.
I have high astigmatism and my initial cataract surgery & intraocular lens was designed to help with this. Does this technique allow for the correction of my astigmatism?
Yes, I am one of the few surgeons in Australia who have successfully used a toric sutured scleral-fixated lens for patients with high astigmatism. Do bear in mind however that this does not guarantee spectacle independence. Even though this will reduce your need for glasses, spectacle correction will still be required for a) near vision, and b) to further refine your distance vision.
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How long do Secondary IOLs last?
Secondary IOLs are designed to be permanent and typically do not need to be replaced.
What can I expect if I have surgery?
The surgical experience is very similar to cataract surgery, with the exception that it is usually a little longer, taking about 60 mins. Surgery is usually done under local anaesthetic with some mild sedation i.e. anaesthesia is used to numb the eye whilst some relaxing medication is given via a drip.
All you have to do is lie still on your back, listen to the relaxing music being played whilst the surgery is performed. After surgery, a pad is used to cover your eye, and you are then discharged home.
How long does recovery take?
I usually advise patients to take at least 2-3 weeks off work and will provide a medical certificate for this. During these 3 weeks, take it easy, avoid any straining or heavy lifting, keep the eye clean, read a book, spend time with the family, watch some Netflix and go out for nice leisurely walks.
Visual recovery is gradual and will take a few weeks as this is a more involved procedure compared to regular cataract surgery.
Are there any risks of surgery?
Yes, as with any surgical procedure (or even daily activities such as driving), there is always a chance that complications can happen. Fortunately however, the risks of serious complications such as an infection inside the eyeball (endophthalmitis) are very low - the risk of this is approximately 1 in 3000 (0.03%). The other way of viewing it is that if surgery is not performed, your vision will NOT improve and may possibly worsen.
Click here for a more detailed explanation of the risks of surgery.