In this study we analyzed the incidence and types of complications seen after cataract surgery and implantation of anterior chamber intraocular lenses (AS-IOLs). This report is based on a review of 4104 explanted AC-IOLs that were submitted to the Center for IOL Research over the past 10 years. The results from pathological examinations were correlated with clinical information. Of the 4104 IOLs, 50% were closed-loop designs (n = 2095/4104), and 22% were open-loop lenses (919/4104). The IOLs most frequently explanted were the closed loop designs Leiske (n = 847) and Stableflex (n = 808). The most important reason for explantation was corneal pathology. Closed-loop IOLs had a much higher complication rate than open-loop lenses. Flexible open-loop AC-IOLs showed the highest explantation rate during the first postoperative year due to surgical problems. The complication rate of closed-loop AC-IOLs increased with implant duration and were responsible for 80% of the corneal pathology. Flexible open-loop AC-IOLs can be an alternative for secondary or exchange implantation. Furthermore, they could also be a viable alternative for cataract surgery in developing countries in order to help catch up with the overwhelming backlog of cases that exist there.