This patient has a dislocated single-piece acrylic IOL that needs to be explanted so that a three-piece IOL can be secured to the sclera using the Yamane technique. The challenge is that the patient has a low corneal endothelial cell count and making the risks higher. If the IOL touches the corneal endothelial surface during removal, it could cause the entire cornea to fail, necessitating a corneal lamellar transplant. What would be your technique of explanting this IOL?
Difficult one. Maybe a modified soft shell technique letting the BSS run filling the eye; then cover the endothelium with a dispersive OVD and below it, sodium hyaluronate. Then the Yamane technique could be performed with the old IOL in place. Once the procedure is over, the IOL could be cut with IOL cutting scissors, more OVD and the cut pieces gently pulled out. Of course, all the OVD. must be removed with IA or Co-axial. One suture to secure the wound. I wouldn’t do it myself.