Surgery: IOL Exchange

Dr. Barber: This is a case of a simple intraocular lens exchange which needs to be a skill that all anterior segment surgeons are comfortable with. This patient had a LASIK, approximately 15 years prior, for a high grade of myopia, and then underwent cataract surgery with the use of a toric intraocular lens implant. This is a single-piece, acrylic lens implant manufactured by Alcon. As you can see here, we’re carefully dissecting the anterior capsule from the anterior surface of the lens implant. This visco-dissection is the most effective way for cases such as this, where there’s minimal capsular fibrosis. With the Alcon lens, the terminal bulb at the end of the haptic is where the capsular fibrosis tends to accumulate the most, so visualizing that and being aware of that is crucial.

So once adequate viscoelastic has been injected both posterior and anterior to the lens implant, the lens implant is elevated into the anterior chamber. This technique is cutting the lens implant to nearly in half, using micro forceps and micro scissors, going 90% across the surface area of the optic. Then grabbing the proximal corner of the first hemisphere of the lens implant, and externalizing it through the primary corneal incision. Again, paying careful attention to the terminal bulbs of the haptics to make sure they are not fibrosed into the peripheral aspects of the capsule.

Once the first part of the lens implant is removed, it will typically self-amputate. And then the second hemisphere of the lens implant is already presented in the incision and can be easily removed in a relatively atraumatic fashion.

The capsule is now inspected and the capsule is filled with a cohesive viscoelastic. The new lens implant is now carefully inserted back into the capsular bag. In this particular case, there was a clockwise rotation of the toric lens. And so based on the staple postoperative refraction, it was determined that the lens should be placed 15 degrees counter-clockwise from the initial implantation axis.

Viscoelastic is now removed and we have our new lens implant carefully centered and properly positioned within the capsular bag.