If a patient needs an intraocular lens explanted, certain lenses can be difficult to manipulate inside the eye, and removal almost always involves enlarging the wound and having to place a suture. Arup Bhaumik, MD, however, of Kolkata, India, has devised a simple way to explant lenses through the original cataract wound using materials that are easy to acquire. Here's how you can do it, too.

First, Dr. Bhaumik gathers together two 20-gauge needles, the A string from a Spanish guitar and an Alcon Monarch A cartridge. All are sterilized. He first makes two short cuts from the tip of the A cartridge down the sides, diametrically across from each other. This allows the opening to open wider. He then blunts the needles' tips by rubbing them on a pumice stone. He also makes two side openings on the needles, up near the blunted tip, by rubbing the sides on the pumice stone until the openings are created. He threads one end of the A string through one opening on one of the needles, then threads the other end through the other opening. He then passes the open ends of the string through the second needle, and secures the string in the second needle with a pinch from a pair of pliers. He slides the needles into the A cartridge. Now, pulling on the second needle will cause the loop to move.

To use the wire loop snare, the surgeon prolapses the IOL into the anterior chamber and introduces the modified A cartridge with the snare into the anterior chamber through the original wound. He then uses a Sinskey hook to engage the lens with the loop of the snare. "It's important to keep the tip of the cartridge in the anterior chamber since it requires more space to open," advises Dr. Bhaumik. Then, a gentle pulling motion on the snare loop will cause the lens to refold into the cartridge. A thicker gauge wire may be necessary for lenses over 24 D to prevent slicing the lens in half. "For a single-piece IOL, it works very well," says Dr. Bhaumik, who's used it for nine explantations so far. 

"However, for a multi-piece lens, such as the AcrySof, it doesn't work as well. One case had a little hyphema the next day and another had mild edema in the corneal wound, but within a week they were fine. We did endothelial cell counts and found no significant differences between this method and conventional explants"

To see Dr. Bhaumik's video, visit revophth.com/snare/.