Surgical Techniques and Indications for Intraocular Lens Explantation: A Narrative Review

While the outcomes of cataract surgery are remarkably positive, complications do still occur, some of which require intraocular lens (IOL) explantation. These complications often include corneal endothelial loss for anterior chamber IOLs, whereas posterior chamber IOLs are usually explanted because of dislocation, opacification, or patient dissatisfaction with visual quality. Surgical management is challenging, with numerous IOL types/methods of implantation requiring different techniques for explantation. En bloc removal is the simplest of techniques, requiring large incisions with large rates of astigmatism. While folding and cutting methods allow for smaller incisions, the extensive manipulation these techniques require do lead to the potential for endothelial trauma. More novel methods such as cartridge-assisted extraction or IOL scaffolding theoretically minimize anterior chamber manipulation and risk of IOL prolapse into the vitreous but are less widely reviewed with few ophthalmologists having experience with the techniques. If the lens has become displaced into the vitreous, one can also cleave the lens prior to moving it the anterior chamber of the eye, thus even more greatly minimizing corneal endothelial damage. Ultimately, the variety of techniques paired with the rarity of explantation make it difficult to develop expertise in each of these many surgical methodologies. Therefore, it is important to review the indications, complications, general principles, and specific steps for each of the approaches to IOL explantation.