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IOL exchange safe and simple with the appropriate technique
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 Uday Devgan |
ROME — IOL exchange is often described as a challenging procedure, with a high risk of intraoperative complications.
One speaker here showed that, with the appropriate technique, it can be mastered safely and efficiently. Cracks and calcifications, dislocation, subluxation, IOL intolerance and wrong power calculation are the most common reasons for explanting a lens, Uday Devgan, MD, OSN Supersite Section Editor, said at the annual joint meeting of Ocular Surgery News and the Italian Society of Ophthalmology.
He said that lens exchange takes time, approximately the time of three phacoemulsification procedures.
"Give yourself plenty of time to do the surgery," he recommended.
The first maneuver is dispersive viscoelastic injection through a sharp 27-gauge needle to help separate the anterior lens capsule. A blunt cannula is then used to further viscodissect the lens out of the capsular bag. Using the same instrument, the lens is gently pushed out in the anterior chamber.
"Leave the old lens in the anterior chamber while you implant the new lens. Once there, it will protect the posterior capsule from damage while you cut and remove the old IOL. Forceps are used to hold the old lens, and microscissors are used to bisect it. The capsule is protected from the sharp tips of the scissors by the new lens," Dr. Devgan said.
When the pieces are removed, Dr. Devgan likes to reassemble them outside the eye to make sure nothing has been left behind.
"From there, everything else is pretty straightforward," he noted.
- Disclosure: Dr. Devgan has no relevant financial disclosures.