When patients need it, I am a firm believer in IOL exchange. We can go back inside the eye and remove the existing IOL and replace it with a different IOL. I have done this countless times for all sorts of patients. But it is not always the best solution. In this case, we have an anonymously submitted video of a patient with a toric EDOF (extended depth of field) IOL that is being replaced with a non-toric EDOF IOL. So that begs the question: what is the issue being treated?
We can assume from the video that the toric IOL is not needed as it is being replaced with a similar IOL without toric correction. If the issue is a myopic refractive surprise, then perhaps LASIK or PRK would be a better solution. If the patient has a spherical equivalent of about plano (emmetropia) and the issue is residual astigmatism, the performing LRIs (Limbal Relaxing Incisions) may be an easier approach and this could even be done at the slit-lamp microscope. However, if the patient has a refractive surprise that is hyperopic, then perhaps the IOL exchange is best.
IOL exchange is not an easy procedure and it carries more risk than the initial cataract surgery. In this case, the contracted anterior capsulorhexis is enlarged but that leads to a runout… life is not always easy. Watch the video to see what happens.
There was no need to expand the capsulorhexis in that case….plenty large enough to exchange that IOL through. If a Rhexis is fibrosed I never try to enlarge it by tearing because it will almost always tear out as you see there in that video. There are other ways to remove a socked in IOL even through a small rhexis. One is to cut the IOL within the capsular bag, another is to expand and stabilize the rhexis with iris retractors. Regardless, the surgeon should do the procedure he is most comfortable with and believe will give the patient the safest and best result. Unfortunately I see the complications of attempted IOL exchange by surgeons who rarely do them referred to me for repair and I agree that in those cases either referral, laser vision correction or doing nothing would have been much better than attempting a procedure one has little experience with.