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    Micro-instrumentation reduces trauma in IOL exchange


    IOL cutting system

    The Packer/Chang IOL Cutting System (MicroSurgical Technology [MST]), developed by Mark Packer, MD, and David Chang MD, provides a set of instruments designed to meet the requirements for a safe IOL exchange. With the 1-mm diameter cannula (19-gauge) of the scissors and the 0.6-mm cannula of the micro-holding forceps (23-gauge), this system works through a 2-mm main incision and 1-mm paracentesis.

    Once introduced, the wound does not gape, allowing the viscoelastic to remain in situ. This set of micro-instruments makes the surgeon’s job easier and improves safety by reducing surgical trauma.


    The low profile of the Packer/Chang IOL cutters are small enough to be introduced entirely into the eye without distorting the cornea, thus enabling precise work without exerting trauma. Because of their innovative design, the scissors also can be used on thickest acrylic IOLs without bending the blades.

    The scissors will cut through any foldable IOL. This system allows surgeons to cut the lens into two or three pieces intraocularly, and remove the fragments through a small wound.

    The 23-gauge Micro-Holding Forceps in this set also are easy to use and can stabilize any IOL. By using the serrated micro-holding forceps through the paracentesis, surgeons can firmly grasp the lens while they cut it through the main incision. The forceps open wide enough to securely grasp any foldable lens material.

    The stand-out aspects of this set of micro-instruments are the ability to cut any foldable IOL, diminish trauma in the anterior segment, and their use through the smallest incisions. They can easily stabilize any kind of IOL.

    The modifications made in the design of this system are similar to vitreoretinal instruments, but they are strong enough to be used for precise maneuvers within the anterior segment.

    Given the high-patient volume, I perform between 20 to 40 IOL exchange cases per year, and I appreciate the benefits offered in this system are important to patient outcomes.



    1.    American Academy of Ophthalmology (2011). Cataract in the Adult Eye (Preferred Practice Pattern). San Francisco: American Academy of Ophthalmology, accessed April 14, 2016.

    2.    George J.C. Jin, “Changing Indications For and Improving Outcomes of Intraocular Lens Exchange”, Am J of Opthalmol, 140(4), 688-694 (2005)

    3.    Uday Devgan, “When All Else Fails: Pearls for IOL Exchange”, Review of Ophthalmology.


    José Luis Güell, MD

    E: [email protected]

    Dr. Güell is an ophthalmologist and founding partner of the Institute of Ocular Microsurgery in Barcelona, Spain, where he is the coordinator of the Cornea, Cataract and Refractive Surgery Department. He also is the coordinator of Anterior Segment at the European School for Advanced in Ophthalmology (ESASO), president of the European Society of Cornea and Ocular Surface Disease Specialists (EUCORNEA), and a lecturer at the Institute of Ocular Microsurgery.

    Dr. Güell has no financial disclosure with MST.

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