2962: this IOL optic can be easily ripped (LAL)
This case highlights a unique and highly useful surgical pearl when performing an intraocular lens exchange involving a Light Adjustable Lens (LAL). While traditional acrylic or silicone IOLs typically require specialized intraocular scissors to bisect the optic before explantation, the specific silicone material of the LAL behaves quite differently. We can use the Twist and Out technique for acrylic IOLs but silicone polymers are too slippery when coated with viscoelastic. As our operating guest surgeon demonstrates, there is absolutely no need to bring scissors into the anterior chamber. Instead, by using two sets of robust forceps, you can simply grasp the optic edges and pull them apart. The material easily rips in a clean, controlled fashion. It is important to note that the LAL does not seem to have the same structural tensile strength as other standard IOLs. This altered material characteristic may be directly related to the lens being post-UV light treatment and final lock-in, which changes the macromers and cross-linking within the polymer. This technique minimizes the risk of accidental iris or capsular damage from scissors and streamlines the explantation process. It is a must-know mechanical property for any surgeon performing a modern IOL exchange.
