Transection and explantation of intraocular lenses using femtosecond lasers

We present 2 cases in which a femtosecond laser was used in vitro to transect hydrophilic acrylic intraocular lenses (IOLs). At 8 μJ with 3 μm spot separation and 6 μm line separation, no charring occurred and there was no increase in total organic carbon. In vivo, the IOLs were successfully transected in the capsular bag (Case 1, opaque IOL) and the sulcus (Case 2, subluxated IOL post-pneumatic displacement of submacular hemorrhage) and explanted through a clear corneal incision (∼3.0 mm). At 3 months, in Case 1, the corrected distance visual acuity (CDVA) improved from 6/24 to 6/5, astigmatism improved by 0.23 diopters, and endothelial cell density (ECD) remained unchanged (1935 to 2210 cells/mm²); in Case 2, the CDVA was hand motion, astigmatism remained unchanged, and ECD decreased (1960 to 1600 cells/mm²), possibly as a result of complex surgery. Femtosecond IOL transection and explantation may be a clinically safe and feasible option for surgeons.