MULTIMEDIA

2^nd I-Care for MEAR Summit:

Exchanging IOLs: Reverse Engineering

The presentation focused on managing complications from sulcus-placed single-piece hydrophobic IOLs, highlighting a case of a 49-year-old woman with high IOP and pigment dispersion glaucoma post-cataract surgery. The speaker discussed challenges including IOL malposition, vitreous prolapse, and uncontrolled IOP. A combined surgical approach was adopted involving IOL explantation, anterior vitrectomy, and a glaucoma procedure (bent-needle goniectomy). Various IOL explant techniques were reviewed, such as the “twist and out” method by Uday Devgan and the cut-free snare and cartridge-based techniques. The speaker emphasized a modified cartridge pull-through method using Grieshaber forceps for safe, minimal-endothelium-trauma explantation. A three-piece IOL was placed before explanting the faulty one to protect the capsular bag. Postoperative outcomes were favorable, with improved vision and controlled IOP. The session concluded with practical insights, stressing the importance of customizing techniques based on IOL type, bag integrity, and surgeon experience.