An Alternative Technique For Intraocular Lens Removal: Bimanual Cleavage In The Vitreous Chamber

To present a new technique for lens explantation, involving intraocular lens (IOL) cleavage in the vitreous chamber using two forceps and successive removal from the anterior chamber.

Retrospective monocentric analysis of 10 eyes affected by IOL subluxation/luxation who underwent IOL explantation and 23-G vitrectomy. After separating the capsular bag rests from the IOL using the vitrectomy probe, serrated forceps were used to grab the IOL, while microscissors performed an "initiation" cut at the midpoint of the lens plate. A second pair of serrated forceps grabbed the IOL plate on the other side. Then, the two forceps were slowly pulled one apart from the other, exerting a separative force perpendicular to the initiation cut and causing the IOL to cleave in two pieces. In case of asymmetric cleavage, a second cleavage was performed. The pieces of the IOL were then moved to the anterior chamber and removed through a clear corneal incision.

Intraoperative mean IOL removal time was 14.1 ± 6.5 minutes. The IOLs (seven 1-piece and three three-pieces IOLs) were successfully explanted with this technique in all patients. Overall, four cases underwent exclusive IOL explantation, and the eyes were left aphakic. Postoperatively, best corrected visual acuity improved in all patients at 1-week follow-up, and no intraoperative or postoperative adverse events were reported. Cornea was completely clear in every case since postoperative Day 1.

Bimanual cleavage technique for IOL removal ensured safer IOL handling in the larger vitreous chamber and minimized the procedures to be performed in the anterior chamber.