Freeing the IOL from the capsular bag
Injecting Viscoat or provisc into the capsular bag at the optic-haptic junction can free up that hapgic. If a cannula with viscoelastic is insufficient to create space in the capsule, then a iris sweep or even a rounded tip 30 needle can gently dissect capsule away from the IOL while viscoat is passed through the needle bore into the capsular bag.
One piece explant technique
An Alcon Acrysof model lens will pass through a 2.2 mm or larger peripheral corneal wound if it is passed with a 'push-pull' technique. By pulling on a haptic out of the main corneal wound and nudging from the anterior chamber with a second instrument the lens will conrorm to the wound and pass through
IOL bisection or trisection
Using long Vannas scissors or specially designed lens cutting scissors the IOL be cut into two or three pieces. Tugging the haptics first out the wound allows easier retrieval of the pieces through a smaller wound.
Lens Folding technique
Once the IOL is into the anterior chamber and out of the capsular bag, the lens folding forceps can be passed into the AC on top of the IOL. A second instrument is used beneath the IOL and with upward pressure presses and folds the IOL into the folding forceps. The IOL is then removed through a 3 mm wound.
IOL explantation is expected to be more common and familiar to ophthalmologists as new technology multifocal lenses and patients lifestyles do not always match 100% with newer multifoclal lenses.
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