[Intraocular lens explantation and secondary implantation of a light-adjustable lens. Video article]

The operation is carried out to exchange previously implanted intraocular lenses (IOL) because of deviation from the target refraction with aniseikonia and anisometropia, in cases of contact lens intolerance, dissatisfaction with the IOL due to side effects and particularly problems with multifocal lenses.

The aim of this surgical approach is to retain the original implantation site of the exchange lens and capsular bag integrity with maximum sparing of the zonular fibers and secondary IOL implantation with stable positioning for fine adjustment of residual refractive errors.

Using a non-astigmatic approach the primary IOL is first mobilized and removed. A light-adjustable IOL is then implanted in the capsular bag and residual refractive errors in the visual axis are adjusted using profiled UV light. The surgical technique is demonstrated in detail with the help of a video of the operation, which is available online.

Residual postoperative deviations from the target refraction of sphere and cylinder up to 2 diopters can be precisely adjusted noninvasively. Individual alterations of asphericity can provide stable distance visual acuity while enhancing near and intermediate visual acuity.