Take-home: Increased procedure volume and patient expectations have made IOL exchange procedures more common. Smaller incisions and the need to reduce trauma require new micro-instrumentation for best outcomes.
Intraocular lens (IOL) implantation is a well-established procedure with a success rate of 95% to 98%.1
Improvements in design, materials, and techniques have helped to optimize outcomes.2
Over the past decade, patients’ expectations have risen along with procedure volumes. Even with precise lens calculations and thorough patient education, the best option for improved vision and patient satisfaction is an IOL exchange.3
While IOL exchange is not a common procedure, most ophthalmic surgeons will encounter the need to explant a lens. The use of micro-instrumentation specifically designed to cut and remove lenses through a small paracentesis can reduce trauma and improve outcomes.
New instrumentation needed
For many years, most IOL procedures have been performed using scissors and forceps designed for extracapsular cataract extraction (ECCE). Over the past decade, many surgeons have adopted manual small incision cataract surgery, which necessitates the use of instruments that enable access through small incisions.
However, where micro-instrumentation is important in IOL exchange is in the phase of lens division and removal. IOL exchange surgery requires the instruments that diminish the potential for ocular trauma and enable the surgeon to remove the lens out through a small incision - one as small as was used to introduce the new lens.
In the past, ECCE scissors and forceps were often modified. However, the length of the arm, and in the case of forceps, width, made it difficult to achieve the optimal angle and manoeuver through small incisions when working inside the eye.
For example, Vannas scissors were designed to work through a wide corneal incision. Yet, forceps designed for use inside the eye are too small and not robust enough for an IOL exchange.