Twist and Out to Explant IOLs

I first saw Jack Chapman MD explain his technique to explant an IOL at a large ophthalmology meeting about 10 years ago. It was fascinating to me since it allowed the surgeon to remove a full-size IOL with a 6 mm optic via the same 2.75mm phaco incision through which it was inserted. Rahul Pandit MD from Houston, Texas, USA uses forceps with thinner arms and he can explant an IOL with this technique through a 2.2 mm incision.

We recently published this technique in the Journal of Cataract & Refractive Surgery (2020; 46:1072-1074). This technique can be used with any acrylic IOL, both single-piece and three-piece.

One important detail of the technique which is not easily seen in surgery videos is hand positioning. By starting with the hand supinated, it allows 300+ degrees of rotation to full roll the IOL optic prior to explanting it.

click below to learn this technique which you will find quite useful:

4 Comments

  1. Dear dr Uday Devgan,

    Thanks again for sharing this video. In the past you showed different video’s of twist and pull the IOL out of the eye. A couple of weeks ago i encountered a break in the posterior capsule after implanting the single piece lens in the bag. Because is was sinking into the vitreous i had to get the lens out. In my head i heard your voice: if a resident can do it you can do it, and so i did. After staining the vitreous and performing anterior vitrectomy i was able to put in a sulcus lens (and also used your rule of 9). The patient did well and had a perfect vision of 20/20, nice result for a 91 year old lady.

    Kind regards

    Jocelyn Kasanardjo

    1. That is great — strong work and we are proud of you! So happy that CataractCoach has improved the level of surgery that we can deliver to our patients. keep up the good work!

  2. Hi! When performing an IOL exchange with this technique would you recommend placing the new lens before removing the old one?

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