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IOL explant using "Twist and Out"

Article presented during the ACVO, 2025 in Grapevine, Texas - USA. Purpose: Cataract surgery by phacoemulsification followed by an acrylic foldable intraocular lens (IOL) implantation is the gold standard method to remove the opacified lens and restore the emmetropic state in all species. Complications with lens implantation can occur (fractures, dislocations), and sometimes implant removal is necessary. This article shows a method to remove the IOL through a small incision using the “Twist and pull” technique. Methods: A 1.2 mm port incision in the clear cornea, 1 mm anterior to the limbus at the 2 o´clock position is created. After making a second clear cornea incision 3.2 mm wide, at 10 o´clock the anterior chamber is filled with cohesive viscoelastic (2.2% sodium hyaluronate) to create space and protect the corneal endothelium. If the IOL is adhered to its lens capsule because of fibrosis, viscodissection can be used to help mobilize it. Using atraumatic lens forceps, the IOL is brought outside its lens capsule and above the iris. With the same forceps, the IOL is fully grasped on its lateral aspect, maintaining it parallel to the iris plane. A lens manipulator is inserted crossing the IOL´s surface holding it in position and avoiding touching the cornea. Using the hand with the forceps, a counterclockwise wrist twist is made until the IOL is coiled removing it at the same time through the main incision. Conclusions: The twist and pull technique is an extremely easy, fast, safe, and atraumatic way to explant an IOL using a small clear cornea incision. Dr. João Alfredo Kleiner MV, MSc www.vetweb.com.br #veterinaryophthalmology #vetweb #oftalmologiaveterinaria #dogs #kleiner #catarata #cirurgia #facoemulsificacao #phaco #surgery #phacoemulsification #cataract #animals #IOL #explant