IOL exchanges and explantations are some of the more difficult cases cataract surgeons are faced with. Eyetube serves as a fantastic forum for sharing the nuances of surgical technique when managing these challenging cases. Below are a series of approaches highlighted on Eyetube.
A Tale of Two Lens Exchanges
This video shows a beautiful demonstration of IOL exchange by Jason Jones, MD. I like the “de-gloving” technique used to get the peripheral bulb of the AcrySof haptic (Alcon) out of the bag versus the mobilization of the “notch” on the Tecnis ZCB00 haptic (Abbott Medical Optics). This video also illustrates great use of a capsular tension ring to stabilize the bag, which I too prefer to do in complex cases. I also like the pearl of “stripping” the fibrotic bands to help with centration of the new lens. Overall, this video packs a lot of information into a short amount of time.
IOL Removal in a Patient With PBK and Cataract
This video demonstrates IOL removal in the case of a phakic IOL causing pseudophakic bullous keratopathy (PBK) and cataract. John Kanellopoulos, MD, shows his cool under pressure when presented with an unfamiliar Russian-made IOL implanted years before. I like how he measured the lens prior to its removal to enable an easier and less traumatic explantation.
Alternatives to IOL Exchange
IOL exchanges and explants don’t always go as well as what Jason and John show in the above videos. Avoidance can often be the best option if possible. Check out this video from Steve Slade, MD, showing how he avoided an IOL exchange in the often difficult situation where you have a symptomatic patient with a multifocal lens and posterior capsule opacity. Do you yag? Exchange? Or, is there another option?
Another alternative to IOL exchange is shown in this video by Cynthia Matossian, MD. Piggyback IOL implantation can be easier to perform than an IOL exchange and is often my procedure of choice in refractive surprises, particularly in a Crystalens platform, where I know the posterior vaulting of the IOL will allow adequate room for the piggyback lens.