Corneal Microlens Removal Enables Trifocal IOL Implantation for Presbyopia Correction

HELSINKI — Successful removal of a corneal microlens for presbyopia, followed by implantation of a trifocal intraocular lens (IOL) in a patient who subsequently developed cataracts, demonstrated the safety, tolerability, and reversibility of the corneal inlay, according to a presentation at the European Society of Cataract and Refractive Surgeons (ESCRS) winter meeting.

Pavel Stodulka, MD, PhD, presented a video detailing the procedure, which he described as straightforward and safe.

Five Years of Spectacle Independence

For five years, the patient had been satisfied with the CorVision corneal microlens (LinkoCare) implanted in one eye, achieving spectacle independence. However, the patient then developed bilateral cataracts. To restore the patient’s previous vision, Dr. Stodulka planned a surgical approach involving explanting the microlens and performing cataract surgery with implantation of a trifocal IOL.

“I planned the surgery not without hesitation since this microlens is tiny and very thin — 20 µm only. It was implanted into a corneal pocket created by a femtosecond laser, and I was afraid I would not be able to open this ancient laser incision and safely enter the pocket with my instruments,” Dr. Stodulka explained. “And then, would I be able to take out this very thin piece of biosynthetic collagen? If I managed all that, what would be the corneal quality and the vision quality with that cornea and trifocal IOL?”

Straightforward Explantation

To his surprise, opening the incision proved uncomplicated, as was accessing the plane above and below the microlens. He grasped the lens with micro-forceps, divided it in half, and removed it without difficulty. The video showed the lens drying and folding upon contact with air. It was then stained with trypan blue, placed in a phosphate buffer solution, and sent to a laboratory in Sweden for evaluation.

“After explantation, the cornea was clear. The pocket was still visible in red reflex but with no sign of scars. I decided to use CAPSULaser (Excel-Lens), my primary technology I use for premium IOLs. Corneal scars are a main contraindication with this technology, but I was quite confident that I could perform a nice, circular, well-centered capsulotomy,” Dr. Stodulka said. “Then I implanted a capsular tension ring, as I do with all trifocal IOLs, removed the cataract and implanted the lens. I did the same in the fellow eye, and 9 days after surgery, the patient was completely spectacle independent. We were happy to witness that this micro-implant is removable and reversible. You can take it out after 5 years … And a trifocal lens fits in without any modifications in IOL power calculation. We hit the target. We expect, within a few weeks or months, that this pocket will be completely invisible even on the slit lamp because there is no scarring whatsoever.”

Laboratory Analysis Confirms Integrity

Laboratory tests confirmed the lens’s clarity remained intact, with no changes in thickness or shape.

“In the past, it was also shown that this material bio-integrates very well into the cornea. Even the corneal nerves can grow through it. It is implanted in into a little pocket, no flap is needed like it was with the other inlays on the market, and the risk of dry eye is really minimized,” Dr. Stodulka told Healio.

Source: Stodulka P. Presbyopic inlay explantation & trifocal IOL implantation. Presented at: European Society of Cataract and Refractive Surgeons winter meeting; March 6-8, 2026; Helsinki.

Disclosures: Dr. Stodulka reports being a shareholder in Excel-Lens and LinkoCare.