Surgery: IOL Exchange

This video demonstrates a simple IOL exchange in a patient who had a multifocal IOL implanted previously and wanted an exchange of the IOL, as he was unable to adjust to the photopsia associated with these lenses.

Surgeon: Dr. Kevin M. Barber, President, Advanced Center for Eyecare Global, USA


This is a simple case of an IOL exchange. Certainly, every cataract surgeon needs to possess the skills, for basic IOL exchange. This patient received a multifocal lens implant three months prior and was having extreme difficulty adapting to the photopsia, associated with this lens implant and the patient desired an exchange for a monofocal lens implant.

So, I’m going through my initial paracentesis, which was relatively easy to open up with viscoelastic cannula, and then doing visco dissection here, just using viscoelastic to separate the capsule from the lens implant, and then injecting more viscoelastic to completely fill the capsule. Now, the most concerning part of this is making sure the terminal bulbs and the haptics are free, that’s where the most fibrosis occurs. And that’s where you’re most likely to tear the capsule.

So, you can see here the trailing haptic has been dislodged from the capsule, we were able to visualize the terminal bulb and here we’re able to do the same thing with the leading haptic. So, this lens is now completely free from the capsule but you do want to always check to make sure that the terminal bulbs are free. The longer the lens has been in there, typically the more fibrosis. So now we’re going to use the MST micro forceps and IOL cutting scissors and attempting to cut this intraocular lens while it’s in the anterior chamber. So, I have elevated up above the capsule to help provide safety and space between where I’m cutting and where the capsule is. There’s plenty of visco elastic beneath.

You can see we’re trying to hold the lens as stationary as possible with the forceps. And we’re going to attempt the Pacman technique here where we cut through about 90% of the lens and then you grab one quarter and pull it out, just as seen here. This time it amputated which it oftentimes well. So no problem, you go back in with a little more viscoelastic and then you can grab that edge with your micro forceps and atraumatically remove it through the same corneal incision without having to enlarge the corneal incision.

So now we’re going to re inflate the capsular bag and inspect and the posterior and anterior capsule appear to be intact. And now we’re going to insert the new monofocal intraocular lens. In this case this is an Alcon Clareon® Monofocal.

Then use a second instrument just to position and center the lens, to make sure it is centered as well again looking for structural integrity of the capsule. Capsule appears to be intact without any defects or deficiencies. We can then remove the viscoelastic material just like you typically would in a standard phacoemulsification.

Then we’ll hydrate the wounds. Check to make sure we have adequate centration of the lens implant. And again, this is just a basic and simple intraocular lens exchange.

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Last Updated: April 6, 2023

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