This overview discusses specific complications after refractive lens exchange (RLE). The complication spectrum is similar to that following cataract surgery, with some differences: RLE is implemented in very short or very long eyes, and the average patient age is significantly lower. Regarding specific situations, this article particularly considers the risks of retinal pathologies after myopic RLE and reviews the typical intraoperative difficulties induced by a short anterior segment in hyperopic RLE. Modern microincisional surgery and the use of foldable intraocular lenses with a sharp edge design reduce posterior capsule opacification and, together with optimal postoperative management, may reduce RLE-specific complications. In summary, despite the minor complication rate, RLE for the correction of high ametropias in the presbyopic age group is a safe and effective refractive treatment option.