When we are doing an IOL exchange, the first step is to carefully dissect the old IOL out of the capsular bag. This must be done with great care so that the capsular bag and zonular support are not damaged. Remember that the capsule is just 4 microns at its thinnest and that is about 1/20th the width of a human hair. Using a sharp 27g needle on the dispersive viscoelastic syringe will allow you to slip under the anterior capsular rim, just above the optic edge. We can then inject the dispersive OVD to help dissect open the capsular bag. Then using a blunt spatula we can sweep all around to free up the IOL haptics completely. We then need to bring this 6 mm diameter optic up through the small 4.5 mm capsulorhexis shown in this case. Finally, we explant the old IOL using our twist technique and then we can insert the new IOL. We also address the 1 diopter of corneal astigmatism at the same sitting.
Click below to learn how to dissect the old IOL out of the capsular bag: