Intraocular Lens Exchange of single piece acrylic lenses after YAG capsulotomy. Shannon Wong, MD.

We encounter this scenario every week in our practice.
The vast majority of these patients have received a presbyopia-correcting lens implant and want a different presbyopia-correcting lens implant.
During the preoperative exam, we determine if an intraocular lens exchange is the appropriate solution to help the patient achieve their visual goals.
Then we dilate the pupil to make sure that the anterior capsulorhexis is
1 well-centered and
2 between 4.5 to 5.0 mm in diameter and
3 if there is 360 degrees of anterior capsule overlap of the lens optic.
It is helpful to obtain an accurate manifest refraction of the patient’s eyes and if possible to know the lens implant type and power. Though it is not required, having the preoperative biometry is also very helpful in selecting the appropriate power for the replacement IOL.

Intraocular lens exchange is performed in our usual manner:
1 topical anesthetic augmented with intraocular lidocaine and oral valium 10mg. We do not use IV sedation.
2 Once the anterior chamber is filled with healon GV, we elevate the anterior capsular rim and viscodissect the IOL from the capsular bag
3 The IOL haptics are viscodissected from the equator of the capsular bag, then the IOL is rotated into the anterior chamber, cut with IOL cutters and removed in two pieces.
4 An anterior vitrectomy is performed.
5 Insertion of the replacement IOL involves placement of the IOL anterior to the anterior capsule, then we hold the edge of the optic with microforceps and use a connor wand to maneuver the lens haptics posterior to the anterior capsular rim.
6 The lens optic is then maneuvered posterior to the anterior capsule.
7 Once the entire lens implant is posterior to the anterior capsule, the optic edge held by the forceps is brought anterior to the anterior capsular rim.
8 Next, a Connor wand is placed posterior to the optic then maneuvered to lift the opposite edge of the optic anterior to the anterior capsule.
9 Then the microforceps and connor wand are used to lift and center the IOL optic so it has adequate support from the anterior capsule on both sides perpendicular to the haptics that are posterior to the anterior capsule.
10 Once the replacement single piece acrylic lens Is in reverse optic capture and the IOL is deemed to be centered and stable, the viscoelastic is removed from the eye using BSS flushed through 27 ga cannulas.
11 Do not perform I/A to remove viscoelastic from the anterior chamber if the IOL is in ROC and there is no capsular support. Whenever I have tried I/A even when lowering the infusion pressure to the lowest setting, I have caused dislocation of the IOL into the vitreous which can potentially necessitate referral of the patient to our retinal colleagues.
Following this process, I have found that IOLX of SPA IOLs after YAG capsulotomy has become a common and very safe procedure in our practice. We have been able to help many patients who had presbyopia correcting lens implants that were miserable very happy with this procedure.

Financial disclosure: I have no financial interests in the products discussed in this video.

Видео Intraocular Lens Exchange of single piece acrylic lenses after YAG capsulotomy. Shannon Wong, MD. канала Shannon Wong, MD