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IOL Exchange in Opacified IOL

Martin Charles MD

Long term IOL opacifications are seen in some hydrophilic acrylic intraocular lenses such as IOLFLEX IOLs commonly implanted in Argentina a few years ago. These lenses commonly developed late opacification approximately 30 months after implantation due to calcium precipitation. This patient was referred with a decreased visual acuity due to an opacification of the IOL. The best-corrected visual acuity was count fingers at 2-meters. She had an uneventful cataract surgery 2 years ago. I planned to perform an IOL exchange using the optic only removal as was described by Yu and collaborators. I performed optical biometry in pseudophakic mode.
The anterior chamber was filled with OVD. A 2.75 mm clear cornea incision was made to address the pre existing astigmatism. A 27-gauge needle was bent in a you shape. With this instrument I pinched the lens from the optic with one hand and made a viscodissection between the lens optic and the posterior capsule. A Packer Chang IOL cutter is used to cut the haptic from the optic. By this maneuver the optic is removed form the capsular bag gaining access to the superior haptic that is cut with the scissor. With a forceps I hold the lens optic and I cut it in two pieces I explanted these two pieces through the cornea incision Using a polymer Irrigation aspiration tip I perform polishing of the posterior capsule opacification leaving a crystal clear surface. The capsular bag was filled with OVD and a one-piece Hydrophobic IOL with blue filter was implanted in the capsular bag. This is the one-week postoperative slit lamp photograph with a visual recovery of 20/20 uncorrected visual acuity
In conclusion in cases of late IOL explanation with capsular adhesions, removal of the optic only technique can reduce intraoperative complications resulting in a safer and reproducible procedure. If we are in presence of posterior capsule opacification polishing of the capsule can be performed in a standard fashion. In the bag one piece IOL implantation may be a good choice for both anatomical and refractive outcome

Posted: 1/15/2013