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    Planning tips and tools for IOL exchange

    Minneapolis—Careful preparation that includes planning ahead and going into surgery armed with the proper equipment and alternative strategies will facilitate easy and atraumatic explantation when performing IOL exchange, said Stephen S. Lane, MD.

    “Assess the preoperative status of the IOL and capsule so that you can determine the best explantation technique, have your tool chest open with the correct instruments available, and be knowledgeable about and ready to use different maneuvers,” said Dr. Lane, medical director, Associated Eye Care, and adjunct clinical professor of ophthalmology, University of Minnesota, Minneapolis.

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    Fundamental to planning IOL exchange is knowledge of the implant design and the position of the optic and the haptics. Surgeons should also know whether the capsulorhexis and posterior capsule are intact.

    The list of tools to use in the procedure includes local anesthestic, which will make patients as comfortable as possible and prevent their movement during the procedure.

    “Unless the surgeon is very comfortable with the techniques for IOL removal, it can be difficult to know how long the case will take,” Dr. Lane said. “It is important that the patient be both comfortable and still during the intraocular maneuvering.”

    He recommended having a variety of hooks, microforceps, and bimanual I/A available for use in pulling and pushing on the lens, microscissors for cutting the implant, and vitrectomy in case it is needed. Intraoperatively, surgeons should work in a closed system as much as possible, under ophthalmic viscoelastic device (OVD), as that will enable manipulating the lens into the anterior chamber where it can be most easily accessed for removal from the eye.

    OVD is also useful to help surgeons find or create a space between the IOL and anterior capsule.

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