One day you will certainly need to know how to insert an AC IOL. Note that these types of IOLs are rigid and non-foldable, typically made of PMMA. This means that a larger incision is required, usually about 6 mm in diameter. The preferred location for this incision is in the sclera with a long enough tunnel length to ensure good sealing ability and a mild effect on astigmatism. In general, I encourage you to avoid enlarging your corneal phaco incision and to instead create a new scleral tunnel. Note that the AC IOL is usually best positioned in the horizontal meridian (the patient’s 3 o’clock to 9 o’clock meridian) for best stability. The physical sizing of the AC IOL is done by measuring the horizontal white-to-white and then adding 0.5 mm. The previous video featured here explained the IOL calculations and the proper orientation. You certainly will need a peripheral iridotomy to avoid pupillary block. Note that AC IOLs will often increase the rate of corneal endothelial cell loss, so they should be used with caution in patients with Fuchs’ dystrophy and other similar conditions. Fortunately, most patients who get an AC IOL do well and achieve good visual outcomes.
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