Refractive Lens Exchange: Experience Matters

Surgeon volume is a major predictor of complications in patients receiving refractive lens exchange (RLE), according to a retrospective case control study involving >18,000 surgeries in >10,000 individuals. Results were presented by Julie M Schallhorn, MD, a cornea, refractive, and cataract surgery specialist at the University of California, San Francisco, during the American Academy of Ophthalmology’s 2018 annual meeting in Chicago. 

The risk factors for cataract surgery are well-known, she noted. They include patient factors such as age, dense lenses, pseudoexfolliation, medical comorbidities, prior eye surgery, and trauma, as well as surgeon factors related to inexperience. However, for refractive lens exchange (RLE), many of the patient factors do not apply, since they tend to be young and without dense lenses. 

Participants (n=10,296) underwent RLE over a 2-year period ending in mid-2016. Surgery was performed by 14 surgeons who were out of residency for ~20 years and performed an average of just over 5 cases per week. Investigators followed them for an average of ~9 months, comparing patients who experienced intraoperative or postoperative complications with those who had no complications. Complications were categorized as serious or non-serious. 

Among the results:

⦁    There were 1,164 complications in 1,112 eyes.
⦁    171 serious events occurred in 165 eyes. 
⦁    There were 748 cases of posterior capsular opacification (PCO) in 748 eyes.
⦁    Surgeon cases/week was a main predictor of non-serious complications; those with more experience were 1.3% less likely to have a patient with a non-serious complication.
⦁    Likewise, more experienced surgeons were 2.2% less likely to have a patient with a serious complication. 
⦁    Age also contributed to serious complications, as each additional year of life increased the odds of experience such by 3%. 
⦁    For every additional case performed/week, there was a 2.2% reduction in the chance of having a seriously complication. 
⦁    More experienced surgeons were 1.7% less likely to have a patient experience PCO.
⦁    Younger patients were more likely to have PCO; each additional year of life reduced the odds of experience PCO by 1.3%.

Schallhorn J. Surgeon Volume Is a Major Predictor of Complications in Refractive Lens Exchange. Talk presented at: AAO 2018 annual meeting; October, 26-30, 2018; Chicago.