Intraocular bag-in-the-lens exchange: indications, outcomes, and complications

Purpose: To report the indications, outcomes, and complications regarding bag-in-the-lens (BIL) intraocular lens (IOL) exchange over a period of 13 years in a tertiary ophthalmologic center. Setting: Department of Ophthalmology of the University Hospital of Antwerp, Belgium. Design: Observational retrospective study. Methods: Between 2003 and 2020, 12 176 patients were operated using the BIL technique. Adult patients who underwent an intraocular BIL exchange were included, and the demographics, indications, outcomes, and complications were recorded. Results: 59 eyes (0.48%) of 59 patients who underwent a BIL exchange between 2007 and 2020 were included. The mean age was 61.15 ± 13.53 years. The mean time between primary surgery and IOL exchange was 25.73 ± 41.88 months. The main indication for explantation was refractive surprise mostly related to patient risk factors, for example, preoperative corneal and refractive surgery. The mean preoperative uncorrected (UDVA) and corrected (CDVA) distance visual acuity were 0.36 ± 0.24 and 0.79 ± 0.24, respectively. The postoperative 1-month UDVA and CDVA were 0.66 ± 0.28 and 0.86 ± 0.19, respectively. The improvement in UDVA was statistically significant (<0.0001). The most common intraoperative complication was damage to the anterior hyaloid in 9 eyes (15%), which did not prohibit reimplantation of a secondary BIL. Conclusions: BIL to BIL exchange was a viable and successful technique that provides good refractive results with few, manageable complications. Because of the tertiary profile of the study center with referral of complex cases, BIL was the preferred IOL in patients at risk for postoperative refractive surprise.