A Toolkit for Secondary IOLs

Clinical Report: A Toolkit for Secondary IOLs

Overview

At the AAO 2026 meeting, Ajay Kuriyan, MD, described a course reviewing dislocated IOL removal and multiple secondary IOL placement techniques. The course emphasized that no single approach is appropriate for every patient; ocular health, prior surgery, and conjunctival health inform technique selection.

Background

Dislocated IOLs may present as posterior segment surgical problems, and their management can require removal and replacement of the lens. The source describes secondary IOL surgery as an important option for retinal specialists, while noting that some techniques have become more widely used in recent years and may not have been covered in all surgeons’ training. When capsular support is inadequate, established options include anterior chamber, iris-fixated, and scleral-fixated IOLs. The AAO course reviewed these approaches and practical considerations for selecting among them.

Data Highlights

The source article reports no numerical or comparative trial data. It describes techniques and selection considerations presented in an instructional course at the AAO 2026 meeting.

Key Findings

The course covered removal of dislocated IOLs that prolapse into the anterior chamber and removal of lenses from the vitreous cavity into the anterior chamber.
Kuriyan emphasized maintaining a small corneal wound during lens removal to limit corneal astigmatism.
Placement options discussed included anterior chamber IOLs, iris-fixated lenses, and scleral-fixated lenses.
Scleral fixation approaches reviewed included the Yamane technique, a trocar-based technique, and Gore-Tex–sutured fixation using MX60 or AO60 lenses.
The course described anterior chamber IOLs as an option for appropriately selected patients and noted that each technique has different advantages and disadvantages.
Patient selection considerations identified in the source included ocular health, prior surgeries, and conjunctival health; the course’s central point was that there is no single best method for every dislocated IOL.

Clinical Implications

The source supports considering the patient’s ocular health, surgical history, and conjunctival health when choosing a secondary IOL approach. It describes several available fixation methods but does not establish one as superior for all patients.

Conclusion

The AAO 2026 course presented secondary IOL surgery as a range of removal and replacement techniques. Selection is individualized rather than based on a single preferred approach.