In rare cases, we may need to explant the IOL and replace it with a different IOL for a different dioptric power or an alternative design. For a compromised capsular bag, a dislocated single-piece acrylic IOL can be replaced with a three-piece IOL for placement in the sulcus. To explant the original IOL we have a few different options, with the main ones being the twist technique or cutting the IOL in half.
This video shows multiple different cases where we either twist to explant the IOL intact or bisect it with micro-scissors. In either situation, I recommend that you place the IOL / IOL pieces on the cornea to ensure that all pieces have been explanted without leaving any parts behind in the eye. This video also gives an external view of the twist technique so that you can see how the straight tying forceps are twisted with one hand to roll up the IOL optic.
When using micro-scissors in the eye, be careful to avoid contact with the capsular bag since the sharp tips could cause capsular damage. One technique is to bring the old IOL into the anterior chamber, then inject the new IOL into the capsular bag, and then use the micro-scissors to cut out the old IOL. This way the optic of the new IOL will protect the posterior capsule from inadvertent damage from the scissor tips.
Click below to learn the various techniques of explanting an IOL: