Daluvoy, MD, an assistant professor at the Duke Eye Center in Raleigh, North Carolina, and fellowship director of the Cornea/Anterior Segment Division, who coauthored the study described earlier. “Needless to say,” he adds, “if you have to remove a lens that’s already in one of these other locations, the process will be very different from an in-the-bag exchange.”ĭoes research suggest that one technique is more successful than another? “One of the purposes of our study was to compare the different techniques used for secondary IOLs and IOL exchanges, to see if one technique stood out as better or worse,” explains Melissa B. Or, the haptics can be fixated in the sclera using Amar Agarwal’s glued-IOL technique or by putting them through the sclera, as in the Yamane technique. A lens can be passively placed in the sulcus between the iris and anterior lens capsule, or it can be actively fixated in the sulcus-sutured to the iris or sclera, for example. “The lens can be inside the capsular bag or partly captured in the bag, as when the optic is captured in the capsulorhexis or even the posterior capsule, and the haptics are in the sulcus. “Of course, you can subdivide these three locations further,” he continues. In some cases, the lens you’re removing may be outside the bag as well. If the entire capsular bag is dropping onto the macula, you might take the lens out and put the new one into the anterior chamber or suture it to the sclera. If the capsule is torn, and the lens is decentering because it’s in the torn bag, you might take it out of the bag and put it in the ciliary sulcus. Capsular bag to capsular bag is common for addressing lens-power errors. A lens exchange can involve removing a lens from any one of these three spaces and then placing a new lens into any one of them. “There are basically three places inside the eye where you can put a lens: the capsular bag, the ciliary sulcus and the anterior chamber. “Once you’ve established the need for a lens exchange, there are multiple scenarios to consider,” he continues. There are three ways to explant a problematic lens: fold it to reduce its size cut it partially or completely or remove it in one piece. But that only happens five percent of the time in my practice. Then you can stick with plan A and swap out the off-lens for an appropriately powered lens. “Very infrequently, you’ll have a situation where everything is perfect except the power of the lens. Miller, MD, chief of the Cataract and Refractive Surgery Division of the David Geffen School of Medicine at UCLA. “When you’re doing an IOL exchange you have to have a plan A, plan B and sometimes a plan C,” notes Kevin M. Here, surgeons share their insights and pearls for deciding when an exchange is appropriate and how to make sure it leads to the best possible outcome. Prior ocular surgery may be a risk factor for IOL exchange.Patients with both monofocal and presbyopia-correcting lenses had improved UCVA and BCVA following IOL exchange.Monofocal IOLs were most often replaced with an anterior chamber IOL presbyopia-correcting lenses were most often replaced with a ciliary sulcus posterior chamber IOL.Eighty percent of presbyopia-correcting lens exchanges were done to address lens-induced visual disturbance. ![]()
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