Modified adaptation of the twist-and-out technique for intraocular lens exchange

Many methods can be used to explant an intraocular lens (IOL) after prior cataract surgery. Here, we describe a modified approach to the twist-and-out technique for IOL removal. The IOL is dissected and brought into the anterior chamber (AC), where 1 haptic is externalized. The adaptation in this technique occurs next; an additional paracentesis is made 180 degrees away from an adjacent side port, and the shaft of a 25-gauge cannula is threaded across the AC to connect these incisions. This maneuver frees both hands to use forceps within the incision, grasp the IOL, and rotate it around the forceps. The use of both hands allows for a smaller, more controlled movement than the original 1-handed pronation. The cannula shaft aids in twisting the IOL tightly around the forceps while protecting the corneal endothelium. The forceps-lens complex is then withdrawn, extracting the IOL whole with 1 efficient movement.