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.
