Exchange of IOGEL hydrogel one-piece foldable intraocular lens for bag-fixated J-loop poly(methyl methacrylate) intraocular lens.

In 1990, IOGEL lenses placed in the capsular bag were reported to displace into the vitreous after neodymium:YAG (Nd:YAG) laser capsulotomy. We exchanged a bag-placed IOGEL lens in one patient after erroneous biometry and capsular opacification. The technique and results of lens explantation, aspiration of Elschnig pearls, and in-the-bag implantation of a modified J-loop poly(methyl methacrylate) (PMMA) lens are demonstrated. Removal of the soft and nonadhesive IOGEL lens was easy. The capsule pockets held patent by the flanges of the taco-style IOGEL lens allowed for easy insertion and bag fixation of the J-style loops. Visual acuity improved from 20/60 to 20/20. Centration of the exchange IOL was satisfactory. In a series of 61 Nd:YAG laser posterior capsulotomies, we did not observe the reported tendency of IOGEL lenses to luxate posteriorly. Therefore, we recommend Nd:YAG discission of the posterior capsule as the preferred approach to posterior capsule opacification with IOGEL lenses. However, the technical ease of the technique makes the explantation and replacement of IOGEL lenses by a bag-fixated PMMA IOL a valid option to correct an erroneous biometry.