Refractive Lens Exchange

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The procedure of replacing the body's natural lens with a synthetic lens (lens exchange) has been used for the correction of cataract  since the 1960's. The procedure described here differs insofar as the lens of a younger person is still clear ("clear lens exchange") and he will loose the ability to accommodate due to the procedure. Therefore, a refractive or clear lens exchange is only indicated in patients 40 years or older who will become presbyopic anyway very soon or in cases of extreme nearsightedness or farsightedness. Nowadays the induced presbyopia can be corrected with multifocal lens implants. 

Synonyms

CLE: clear lens exchange/extraction

PRELEX: presbyopic lens exchange (when a multifocal lens is implanted)

Indication
  • Farsightedness over +8 dpt.
  • Nearsightedness exceeding -20 dpt. 
  • Presbyopia or loss of accommodation
  • Cataract
Features
  • rehabilitation within one week
  • good predictability of the result
  • loss of accommodation (reading glasses become necessary unless a multifocal lens is implanted)
  • non-reversable
  • both eyes can undergo the procedure within a few days
The procedure 

The patient receives an artificial synthetic, biocompatible lens with life long durability. Prior to surgery, the strength (refractive power) of the new lens will be precisely calculated based on ultrasonic measurements. 

The surgery is generally done under local anesthesia. It lasts only 15-20 minutes and consists of two steps:

First, the body's natural lens is removed: the anterior lens capsule is opened by a small 2.8 mm circular peripheral incision.

Through this small incision, the lens nucleus is emulsified (phacoemulsification) and the nucleus and lens fragments are aspirated.

Now, the removed lens is replaced with a synthetic lens. With a special instrument, the lens is "injected" into the empty lens capsule through the small peripheral opening.

If folded, it slowly unfolds and now replaces the natural lens.

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