Staining of intraocular lenses with various dyes: a study of digital image analysis

PURPOSE: To evaluate the interaction of various intraocular lens (IOL) materials with commonly used dyes. MATERIALS AND METHODS: One IOL of each of the five groups (polymethylmethacrylate, silicone, three-piece hydrophobic acrylic, single-piece hydrophobic acrylic and single-piece hydrophilic acrylic) was bathed in trypan blue 0.1%, fluorescein sodium 2% and indocyanine green (ICG) 0.5% for 15 min. Digital photographs of the IOLs were obtained prior to bathing and after the 15-min bath in each dye. The same IOLs were immersed in the same dye for another 15 min and digital images were reobtained to depict the 30-min dye uptake. New IOLs from the group that exhibited visible colour change after the 15-min bath were then bathed in twofold dilution and if there was still visible dye uptake, fourfold dilution was performed, repeating the 15-min bath and digital photography. The images were then processed using Adobe Photoshop 5.1 to get mean luminosity and red-green-blue values. These values were compared between the groups and the undyed control. Also, dye washout was observed in serum-containing vials. RESULTS: None of the polymethylmethacrylate, silicone and hydrophobic acrylic IOLs were stained with the dyes used. The only IOL material that changed colour was hydrophilic acrylic and did so with all dyes. The most marked colour change was with fluorescein sodium 2%, the least was with trypan blue 0.05%. Twofold dilution of trypan blue and fourfold dilutions of fluorescein sodium and ICG still stained the hydrophilic acrylic IOL; however, fourfold dilution of trypan blue did not cause a significant colour change. Trypan blue washed out within 6 h, while the IOL stained with ICG remained stained for longer than 24 h. COMMENT: Hydrophilic acrylic IOLs should be used with caution together with dyes since this material demonstrates marked dye uptake and washout may also take some time.     

Interaction of intraocular lenses with various concentrations of silicone oil: an experimental study

The aim of this study was to evaluate the interaction between various widely used intraocular lenses (IOLs) and silicone oils of different viscosities. Four groups of IOLs, including monoblock foldable hydrophilic acrylic IOLs (Morcher, type 92s); monoblock hydrophobic acrylic IOLs (Acrysof-SA60AT, Alcon); single-piece rigid polymethylmethacrylate (PMMA) IOLs (Intraocular Optical International-IOI-65130) and a three-piece foldable silicone optic IOL (CeeOn Edge 911A, Pharmacia UpJohn) were analyzed in vitro to determine the percentage adherence 1,000-centistoke, 1,300-centistoke or 5,000-centistokes silicone oil on the IOL optic. For each IOL type, there was no statistically significant difference in the mean silicone oil coverage (MSC) of the IOL optics for the different viscosities of silicone oil. Silicone IOLs had the highest MSC percentage (79.9%) whereas hydrophilic acrylic IOLs were the least silicone-covered IOLs (7.8%) compared to the other IOL types tested in this study. It is not the concentration of silicone oil that affects silicone oil coverage. When performing small-incision cataract surgery in patients who may require silicone oil injection, foldable hydrophilic acrylic or hydrophobic acrylic lenses should be preferred over standard foldable silicone lenses.     

Adherence of triamcinolone acetonide to various intraocular lens materials

PURPOSE: To determine the adherence of triamcinolone acetonide to various intraocular lens (IOL) materials. SETTING: Department of Ophthalmology, Dokuz Eylül University, Izmir, Turkey. METHODS: Four IOLs of 4 materials (single-piece poly(methyl methacrylate) [PMMA], 3-piece foldable silicone, 3-piece hydrophobic acrylic, and single-piece hydrophilic acrylic) were first immersed in triamcinolone acetonide (40 mg/mL) for 15 minutes and then bathed in a balanced salt solution for another 15 minutes. Afterward, each lens optic was examined under light microscopy and digital images were obtained with a digital color video camera. The percentage of optic area covered with triamcinolone acetonide was determined by image analysis. RESULTS: Mean triamcinolone coverage was 7.62% +/- 4.06% (SD) for PMMA IOLs (range 1.97% to 11.43%), 9.09% +/- 4.60% for silicone IOLs (range 4.70% to 15.32%), 8.75 +/- 7.20% for hydrophobic acrylic IOLs (range 1.31% to 16.86%), and 23.16 +/- 8.53% for hydrophilic acrylic IOLs (range 15.02% to 35.12%). Adherence of triamcinolone acetonide to hydrophilic acrylic lenses was statistically significant when compared with other IOL materials. CONCLUSION: Intraoperative triamcinolone injection may obscure visualization intraoperatively and postoperatively, especially in eyes with hydrophilic acrylic lenses, because triamcinolone acetonide seems to have a tendency to adhere to hydrophilic acrylic lenses in vitro.     

Effect of blue staining of expandable hydrophilic intraocular lenses on contrast sensitivity and glare vision

PURPOSE: To evaluate the effect of trypan blue staining of expandable hydrophilic acrylic intraocular lenses (IOLs) on contrast sensitivity and glare. SETTING: Department of Ophthalmology, Federal University, and Oculistas Associados, Rio de Janeiro, Brazil. METHODS: Phacoemulsification with expandable hydrophilic IOL implantation was performed in 19 eyes. Group 1 (stained group) consisted of 12 eyes with the IOL unintentionally stained by trypan blue 0.1% solution during surgery; Group 2 (unstained group) consisted of 7 eyes with IOLs that were not stained because trypan blue was not used during surgery. The eyes were examined postoperatively for Snellen best corrected visual acuity (BCVA), contrast sensitivity BCVA, and glare vision. The examiners were masked to whether the IOL was stained by trypan blue. Inclusion criteria included a BCVA of 20/30 or better 1 month postoperatively. Patients who had other ocular pathology or previous ocular surgery were excluded from the study. RESULTS: The mean postoperative BCVA was 20/24 in the stained group and 20/23 in the unstained group (P =.73). The mean contrast sensitivity visual acuity was 20/31 in the stained group and 20/26 in unstained group (P =.10). The mean glare visual acuity was 20/75 and 20/33, respectively (P =.03). CONCLUSIONS: Patients with expandable hydrophilic acrylic IOLs stained with trypan blue performed significantly worse on a glare vision test than patients whose IOLs were not stained. Cataract surgeons should avoid using trypan blue with this IOL type.     

Incision width after phacoemulsification with foldable intraocular lens implantation

PURPOSE: To determine the incision size after insertion of foldable intraocular lenses (IOLs) using both a forceps and injectors. SETTING: Intermountain Ocular Research Center, Moran Eye Center, University of Utah, Salt Lake City, Utah, USA. METHODS: One hundred patients had phacoemulsification through a clear corneal wound. The incision width was measured before and after IOL implantation. A 3-piece silicone IOL and a 3-piece acrylic IOL (both with an optic diameter of 5.5 mm) were inserted using a forceps. A plate-haptic silicone lens and a 3-piece silicone lens with a 6.0 mm diameter optic were inserted using an injector. RESULTS: The wound size in the group with the 3-piece silicone lens inserted with a forceps enlarged 4.4% (3.23 to 3.38 mm) in the low-power IOL group (15.0 to 20.0 diopters [D]) and 6.2% (3.24 to 3.44 mm) in the high-power IOL group (20.5 to 25.0 D). Similarly, the acrylic IOL wound enlarged 5% (3.21 to 3.37 mm) in the low-power IOL group and 6% (3.25 to 3.44 mm) in the high-power IOL group when a forceps was used. The 3-piece silicone and plate silicone lenses inserted using an injector enlarged the wound 3.2% and 3.3% (3.02 to 3.11 mm and 3.05 to 3.15 mm), respectively. There was no difference in the wound size with higher IOL powers in eyes with injected lenses. CONCLUSIONS: Clear corneal incisions enlarge after insertion of foldable IOLs in a predictable manner, with a forceps-inserted IOL enlarging the wound diameter more than lenses inserted with an injector. The forceps-inserted lens group also showed a difference in wound size related to IOL power.     

Digital image analysis of trypan blue and fluorescein staining of anterior lens capsules and intraocular lenses

PURPOSE: To study the intensity of trypan blue and fluorescein staining over time in anterior lens capsules and various intraocular lens (IOL) materials. SETTING: Fritz Eye Associates, Geislingen, Germany. METHODS: Excised anterior lens capsules and IOLs were exposed to trypan blue 0.1% and fluorescein 2% solution to assess the time correlation of color saturation. A technique of color differentiation using red-green-blue analysis was used. RESULTS: In the anterior lens capsules, trypan blue saturation was 17% after 60 seconds and 71% after 24 hours; with fluorescein, there was no visible staining after 5 minutes and 17% saturation after 24 hours. Red and green light transmission was reduced with trypan blue and high with fluorescein. Blue light transmission was reduced with fluorescein. In poly(methyl methacrylate) and silicone IOLs, there was no to minimal staining and in acrylic IOLs, there was intense uptake of both dyes. CONCLUSIONS: The implications of this surgical technique are to use a short exposure time with trypan blue and avoid acrylic IOLs in cases of questionabale dye loss to the vitreous. Fluorescein should be used as a dye only when injected subcapsularly.     

Intraocular lens materials and styles: A review

Biomaterial science has lead to the development of a variety of foldable intraocular lens (IOL) biomaterials. This literature review examines these lenses from both a basic science and a clinical perspective. By most parameters, hydrogel, soft acrylic and silicone IOL are better than polymethylmethacrylate (PMMA) lenses.
Plate haptic silicone IOL have the lowest incidence of cystoid macula oedema and posterior capsule opacification, but these lenses require an intact anterior capsularhexis and posterior capsule. Yttrium aluminium garnet (YAG) laser capsulotomy must be delayed at least 3 months to avoid posterior lens dislocation. Silicone has the lowest threshold for YAG laser damage of all IOL materials and also adheres irreversibly to silicone oil with subsequent optical impairment. Three piece silicone IOL with polypropylene haptics have a higher incidence of decentration, pigment adherence and capsule opacification compared with PMMA haptics. Hydrogel lenses are very biocompatible and resistant to YAG laser damage, but pigment adheres to the surface more readily than PMMA. Soft acrylic IOL unfold slowly, resulting in controlled insertion, but it is possible to crack the lens and some lenses develop glistenings due to water accumulation.
There are significant socioeconomic implications to the large differences in posterior capsule opacification rates between the various biomaterials and the lens styles.     

Intraocular lens staining associated with Prosed/DS

A 59-year-old pseudophakic woman with a history of Prosed/DS use demonstrated a discolored Tecnis Z9001 (AMO) silicone intraocular lens (IOL). Polymethyl methacrylate (PMMA), hydrophobic acrylic, silicone, and Collamer IOLs were submerged in a physiologic concentration of methylene blue at 35 degrees C for 8 weeks and evaluated. No staining was noted in PMMA or hydrophobic acrylic IOLs, variable staining was noted in silicone IOLs, and intense staining was noted in Collamer IOLs. This is the first report of IOL staining with systemic use of methylene blue and of Collamer lens staining characteristics.     

Neodymium:YAG capsulotomy rates following phacoemulsification with implantation of PMMA, silicone, and acrylic intraocular lenses

BACKGROUND AND OBJECTIVE: Posterior capsular opacification (PCO) is the most common visually disabling sequela of modern cataract surgery. Methods of reducing its incidence include the development of newer surgical techniques and intraocular lens (IOL) materials and designs. The aim of this study was to compare the incidence and time interval of development of PCO, and the requirement of laser capsulotomy in patients implanted with a polymethylmethacrylate (PMMA), silicone, or acrylic IOL. PATIENTS AND METHODS: The data of 340 consecutive patients who underwent phacoemulsification and implantation ofa PMMA, silicone, or acrylic intraocular lens were analyzed. The aim of this study was to compare the incidence and time interval of development of PCO, and the requirement of laser capsulotomy in patients implanted with a PMMA, silicone, or acrylic IOL. RESULTS: The incidence of PCO was found to be significantly less in the acrylic group (6.5% as compared to 21.74% and 26.6% in the PMMA and silicone groups, respectively; P = 0.01297 and 0.0039). Most patients (65%) exhibiting PCO in the PMMA group developed it within the first six months. In the silicone group, development of PCO was delayed. In 60% of patients, it appeared 18 months after surgery. Neodymium:YAG capsulotomy was required in 45% and 60% of patients developing PCO in the PMMA and silicone groups, respectively, while it was required in only 1 of the 4 patients developing PCO in the acrylic group. CONCLUSION: This study indicates that implantation of an acrylic IOL helps reduce the incidence of PCO as well as the need for Nd:YAG capsulotomy. PMMA IOLs require Nd:YAG capsulotomy earlier in the postoperative period as compared to silicone IOLs.     

Comparison of glistenings in intraocular lenses with three different materials: 12‐year follow‐up

Purpose: To compare the degree of lens glistenings associated with three intraocular lenses (IOLs) of different materials and examine the relationship between the dioptric power of the optics and lens glistenings in a long‐term study. Setting: St. Erik Eye Hospital, Stockholm, Sweden. Methods: Forty‐six eyes of 46 patients underwent standard phacoemulsification and implantation with a heparin‐surface‐modified (HSM) polymethylmethacrylate (PMMA) IOL, a silicone IOL or a hydrophobic acrylic IOL. Evaluations of the patients and the glistenings were conducted 11.3–13.4 years postoperatively. The glistenings were examined using Scheimpflug imaging and subsequently analysed using an image analysis program. Results: The median follow‐up time was 12.2 years (range, 11.3–13.4). The hydrophobic acrylic IOL had significantly more lens glistenings than the silicone (p = 0.003) and the PMMA (p = 0.000) IOLs. The silicone IOL had significantly more lens glistenings than the PMMA lens (p = 0.048). The IOL power did not affect the degree of lens glistenings in the hydrophobic acrylic IOL group (p = 0.64). The other groups had too little lens glistenings to evaluate the relationship. Conclusion: In this long‐term follow‐up study, the hydrophobic acrylic IOL had a significantly higher degree of lens glistenings compared to the silicone and PMMA IOLs. The PMMA IOL had almost no lens glistenings. The IOL dioptric power was not significantly correlated with the degree of lens glistenings associated with the hydrophobic acrylic IOL.     

Decentration and tilt: silicone multifocal versus acrylic soft intraocular lenses

PURPOSE: To compare differences in decentration and tilt between a silicone multifocal and an acrylic intraocular lens (IOL) by evaluating postoperative changes. SETTING: Department of Ophthalmology, College of Medicine, The Catholic University of Korea, Seoul, Korea. METHODS: Forty eyes of 20 patients with IOL implantation were randomized into 2 groups according to IOL type: 3-piece silicone multifocal IOL or 3-piece acrylic IOL. All lenses were implanted in the capsular bag through a clear corneal incision after continuous curvilinear capsulorhexis and phacoemulsification. The amount of the decentration and the degree of the tilt of each IOL were measured using the EAS-1000 anterior eye segment analysis system 1 day and 1 and 2 months after surgery. RESULTS: No significant difference in decentration and tilt was found among the 3 follow-ups or between lens types. CONCLUSION: Neither IOL decentration nor tilt showed significant progression up to 2 months in eyes with a silicone multifocal or acrylic IOL when the IOLs were placed properly in the capsular bag. The amount of decentration and tilt was similar between lens types.     

Biofilm formation by Staphylococcus epidermidis on intraocular lens material

PURPOSE: To compare biofilm formation by Staphylococcus epidermidis on different intraocular lens (IOL) materials. METHODS: The S. epidermidis strains, ATCC 12228 (American Type Culture Collection) and ATCC 35984 (biofilm-producer) were used. Biofilms were cultivated on disks of different IOL materials: silicone, PMMA (polymethylmethacrylate), acrylic, or MPC (2-methacryloyloxyethyl phosphorylcholine) surface-modified acrylic. Biofilms were stained with crystal violet (CV) which served as an index of biofilm formation. The bacterial population was enumerated after biofilm homogenization. Biofilms were also examined by scanning electron microscopy (SEM). RESULTS: Among the four materials tested, the least amount of biofilm formed on silicone. Biofilm production was significantly different between acrylic and MPC surface-modified acrylic lenses at 48 hours (P<0.05-0.01). The bacterial populations were significantly different between acrylic and silicone over 72 hours (P<0.05-0.01). The population on acrylic and MPC surface-modified acrylic continued to increase over 72 hours. The biofilm was recognized after a 24-hour incubation. Rates of biofilm-positive SEM fields, which were defined as being occupied by biofilm over at least half of the area, were significantly different between acrylic and silicone at 72 hours (P<0.05-0.01). CONCLUSIONS: S. epidermidis formed biofilm most intensely on acrylic among the four IOL materials tested. MPC surface-modified acrylic has a preventive effect on biofilm formation.     

Effects of cataract extraction with intraocular lens placement on scanning laser polarimetry of the peripapillary nerve fiber layer

PURPOSE: To determine the effects of cataract extraction with intraocular lens placement on scanning laser polarimetry of the peripapillary nerve fiber layer. DESIGN: Cohort study. METHODS: Thirty-four eyes of 33 patients undergoing phacoemulsification cataract surgery with intraocular lens were imaged using the GDx Nerve Fiber Analyzer within 4 weeks before and at least 4 weeks after cataract surgery. Preoperative and postoperative mean images were compared. The effects of cataract severity and type, and intraocular lens material, were also examined. RESULTS: Comparison of preoperative and postoperative mean scanning laser polarimetry measurements revealed that eyes in which acrylic intraocular lenses (n = 11) were placed had a significant increase in scanning laser polarimetry for the total band circumference, and superior, inferior, and nasal quadrants (P < or =.041). Placement of silicone (n = 15) and polymethylmethacrylate (n = 8) intraocular lenses did not result in statistically significant changes in scanning laser polarimetry measurements. However, eight of 34 eyes (23.5%) had changes of 15% or more postoperatively in the total circumference measurement, including eyes with acrylic, silicone, and polymethylmethacrylate intraocular lenses. CONCLUSIONS: Cataract extraction with intraocular lens was associated with a statistically significant change in mean scanning laser polarimetry values in eyes that received an acrylic intraocular lens. In individual patients, clinically important changes (15% or greater) in scanning laser polarimetry measurements were not uncommon irrespective of intraocular lens type. New baseline scanning laser polarimetry measurements may be warranted in eyes that undergo cataract extraction with intraocular lens.     

Permanent blue discoloration of a hydrogel intraocular lens by intraoperative trypan blue

A 79-year-old white man had cataract surgery in the right eye with implantation of an Acqua intraocular lens (IOL) (Mediphacos). Trypan blue 0.1% was used during surgery to stain the anterior capsule and enhance the contrast during capsulorhexis. Seven days after surgery, the patient presented with "dark and double" vision (monocular diplopia). The IOL was decentered superiorly and appeared dark blue. The lens was explanted 2 months after surgery and sent for gross and microscopic analyses in a dry state and after hydration. The same analyses were performed on 2 unused lenses of the same design that had been immersed in diluted trypan blue solutions (0.01% and 0.001%). On the explanted lens, the dark blue staining was denser in the optic, especially in its periphery. The blue discoloration could not be removed after 24 hours of lens immersion in a balanced salt solution at 37 degrees C. Permanent staining of the unused lenses was also obtained after immersion in the trypan blue solutions.     

Differential responses of human lens epithelial cells to intraocular lenses in vitro: hydrophobic acrylic versus PMMA or silicone discs

Background The purpose of this study was to determine the influence of different materials of intraocular lenses (IOLs) on human lens epithelial cell behavior, including adhesion, migration, proliferation, apoptosis, and epithelial-mesenchymal transdifferentiation (EMT) in vitro. Methods Human lens epithelial cells (SRA 01/04) were grown on hydrophobic acrylic (Acrysof), polymethylmethacrylate (PMMA), and silicone IOLs. Cellular adhesion, migration, proliferation, and apoptotic assays were performed to assess cell behavior. The expression of EMT markers (fibronectin and type I collagen) produced by cells on IOLs was determined by immunoblotting and immunocytochemistry. Results Human lens epithelial cells exhibited preferred adhesion and reduced apoptosis when cultured on acrylic IOLs, in comparison to PMMA and silicone IOLs. Cells grown on acrylic lenses formed a confluent epithelial monolayer. Migration of lens epithelial cells under the acrylic lens was substantially blocked in an in vitro assay. In contrast, cells grown on PMMA and silicone lenses displayed a spindle-shaped, myofibroblast-like morphology, increased apoptosis, reduced adhesion, and enhanced production of EMT proteins such as fibronectin and type I collagen. The migration of lens epithelial cells under PMMA and silicone IOLs was substantial in the in vitro assay. Conclusion This report demonstrates that hydrophobic acrylic lenses are more capsular biocompatible than PMMA and silicone lenses. The in vitro assays are reliable measurements for evaluating the responses of human lens epithelial cells to different IOL materials, and could advance our understanding of the preferential capsular opacification conferred by different IOL materials.     

Comparison of the effect of polymethylmethacrylate and silicone intraocular lenses on rabbit corneal endothelium in vitro

An in vitro comparison of corneal endothelial damage caused by polymethylmethacrylate and by silicone intraocular lenses was made. Endothelial damage was assessed by vital staining of corneal endothelium immediately following direct contact with an intraocular lens. Silicone lenses produced less damage than polymethylmethacrylate lenses. The difference could be attributed to a specific type of damage-membrane stripping-seen only after contact with polymethylmethacrylate lenses.     

An in vitro study of human lens epithelial cell adhesion to intraocular lenses with and without a fibronectin coating

PURPOSE: To demonstrate differences in human lens epithelial cell adhesion to different intraocular lens biomaterials in vitro and to determine whether these differences can be influenced by coating the intraocular lens surface with commercially available fibronectin. METHODS: A prospective laboratory-based study comparing human lens epithelial cell adhesion to silicone (n=18), polymethylmethacrylate (PMMA; n=18), and acrylic (n=18) intraocular lenses in vitro. The three types of intraocular lenses were then coated with fibronectin: silicone (n=6), PMMA (n=6), and acrylic (n=6). The main outcome measure was the mean number of lens epithelial cells attached to each lens type after 24 hours of incubation. RESULTS: In the uncoated lens group, there was a significantly higher number of lens epithelial cells attached to the acrylic than to the silicone or PMMA lenses (P<0.001). Coating the lenses with fibronectin caused a significant increase in attachment of lens epithelial cells for all three lens types. CONCLUSIONS: There was a significant difference in the degree of lens epithelial cell attachment to the various types of intraocular lenses in vitro. Cell attachment was more prominent in the acrylic lenses, but the fibronectin coating negated differences in lens type and caused a significant increase in cell attachment across all groups.     

Late postoperative opacification of hydrophilic acrylic intraocular lenses

BACKGROUND AND OBJECTIVE: To evaluate the incidence of postoperative opacification of hydrophilic acrylic intraocular lenses (IOLs) and discuss the surgical management. PATIENTS AND METHODS: Seventy-two eyes of 72 consecutive patients who received the same type of hydrophilic acrylic IOL (Intraocular Optical International, I.O.I., California, USA) after uneventful phacoemulsification were evaluated retrospectively. Systemic status, follow-up time, recognition time of IOL opacification, time lapse between implantation and explantation, and surgical technique during explantation were reported. RESULTS: IOL opacification was noted in 3 patients (4.1%). Time lapse between implantation and first recognition of opacification was 6.3+/-1.5 months (range: 5-8 months). Two of the patients had insulin-dependent diabetes mellitus and both were on renal dialysis for diabetic nephropathy, whereas one had no systemic disease. Opacified hydrophilic acrylic IOLs were exchanged with Acrysof IOL, and no further opacification occurred after lens exchange. CONCLUSION: Use caution on implantation of hydrophilic IOLs because late opacification is a serious complication requiring further surgery.     

Complications of foldable intraocular lenses requiring explantation or secondary intervention--2003 survey update

The sixth annual survey of complications associated with foldable intraocular lenses (IOLs) requiring explantation or secondary intervention was sent to members of the American Society of Cataract and Refractive Surgery and the European Society of Cataract and Refractive Surgeons. Preoperative data about visual acuity, patient signs and symptoms, and complications requiring IOL removal were evaluated. Complications were then tabulated for each of the following major foldable IOL groups: 3-piece monofocal silicone, 3-piece hydrophobic acrylic, 1-piece hydrophobic acrylic with haptics, 3-piece hydrophilic acrylic (hydrogel), 1-piece hydrophilic acrylic (hydrogel), 1-piece plate-type silicone, 3-piece multifocal silicone, and Collamer. Two hundred seventy-three surveys were returned for evaluation. Dislocation/decentration, incorrect lens power, IOL calcification, and glare/optical aberrations were the most common reasons for removing foldable IOLs. Good surgical technique, accurate IOL power measurements, and high manufacturing standards for foldable IOL materials and designs are the most important factors in avoiding complications with foldable IOLs.     

Complications of foldable intraocular lenses requiring explantation or secondary intervention--2001 survey update

A survey of the complications associated with foldable intraocular lenses (IOLs) that required explantation or secondary intervention was sent to members of the American Society of Cataract and Refractive Surgery and the European Society of Cataract and Refractive Surgeons. Preoperative data about visual acuity, patient signs and symptoms, and complications requiring IOL removal were assessed. Postoperative results and outcomes were also analyzed. Complications and symptoms for each of the following major groups of foldable IOLs explanted were tabulated separately: 3-piece hydrophilic acrylic or hydrogel; 3-piece monofocal silicone; 3-piece hydrophobic acrylic; 1-piece hydrophobic acrylic with haptics; 3-piece multifocal silicone; 1-piece plate-type silicone. A total of 286 surveys were returned for evaluation. Intraocular lens calcification, incorrect lens power, optical visual aberrations, and decentration/dislocation were the most common reasons for removing a foldable IOL. Accurate IOL measurements, meticulous surgical technique, proper patient counseling, and careful manufacture of foldable IOL materials are the most important factors in avoiding complications with foldable IOLs.