1135: IOL cutting for IOL exchange

Our guest surgeon is Jeff Whitman MD from Dallas, Texas, USA who shows us his technique for IOL exchange. While my preferred technique is the twist-and-out method to remove an acrylic IOL (6mm optic) via a 2.75 mm incision, another option is to cut the IOL into halves and then pull these straight out. Note that the optic is cut about 90% through but a small zone of attachment is left. This allows the first half to help pull the second half out of the eye. Another great pearl is to place the new IOL in the capsular bag while the old IOL is up in the anterior chamber. This scaffold technique allows the optic of the new IOL to protect the posterior capsule from the scissor tips.

click to learn how to cut the IOL for exchange using the scaffold technique:


  1. Dr Devgan,

    Thank you again for this nice video. Would you advice to implant the proper IOL in the bag before you perform the twist and out technique? In all of my cases where i had to explant the IOL, with an intact posterior capsule i put in the right IOL first. With a broken posterior capsule I twist and pull out first followed by sulcus IOL implantation. I am a big fan of your twist and out technique.

    Best regards and keep on posting!

    1. Yup. You’re right. At least the title slide has the correct name. It was late and it ain’t easy posting a new video everyday for more than 1100 days in a row.

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