Visual Acuity Outcomes and Complications after Intraocular Lens Exchange: An IRIS® Registry Analysis

To assess risk factors for worse visual acuity (VA) outcomes after intraocular lens (IOL) exchange, and the most common postsurgical complications.Retrospective cohort study.Eyes from patients aged 18 years and older in the IRIS® Registry (Intelligent Research in Sight) that underwent IOL exchange in the United States between 2013 and 2019.VA improvement compared to baseline was determined at 1-year postoperatively. A multivariable general estimating equation model adjusting for demographic factors and baseline vision was used to identify factors associated with VA worse than 20/40 at 1-year postoperatively.VA outcomes and postoperative complications following lens exchange.A total of 46,063 procedures (N=41,925 unique patients) were included in the analysis. Overall VA improved from mean (±standard deviation (SD)) logarithm of the Minimum Angle of Resolution (logMAR) 0.53±0.58 (Snellen 20/70) pre-operatively to mean logMAR 0.31±0.40 (20/40) at 1-year postoperatively. Among eyes with VA recorded at both baseline and at 1-year postoperatively, 60.5% achieved VA of 20/40 or better at 1-year. VA of worse than 20/40 at 1-year was associated with greater age (odds ratio (OR) 1.16 per 5-year increase, 95% confidence interval (CI): 1.14-1.18) and higher logMAR baseline VA (OR 1.14 per 0.1 increase, 95% CI: 1.14-1.15), as well as Black or African American (OR 1.96, 95% CI:1.68-2.28), Hispanic (OR 1.82, 95% CI:1.59-2.08), and Asian (OR 1.48, 95% CI:1.21-1.81) versus White race, Medicaid (OR 1.78, 95% CI:1.40-2.25) vs. private insurance, smoking (OR 1.22, 95% CI:1.11-1.35), and concurrent anterior (OR 1.65, 95% CI: 1.51-1.81) and posterior (OR 1.53, 95% CI: 1.41-1.66) vitrectomy vs. no vitrectomy. Female sex (OR 0.93, 95% CI:0.87-0.99) was associated with 20/40 or better VA at 1-year. At 1-year epiretinal membrane (10.9%), mechanical lens complication (9.4%), and dislocation of the replacement lens (7.1%) were the most common complications.In this large national cohort, the annual number of IOL exchanges rose steadily over time. Vision improved in 60.2% of patients; worse visual outcomes were associated with greater age, worse baseline vision, Black race, Hispanic ethnicity, Medicaid insurance, smoking, and concurrent vitrectomy. Epiretinal membrane was the most common complication.