Advances in small incision surgery have enabled
cataract surgery to evolve from being concerned primarily with the safe removal of the opaque crystalline lens to a procedure refined to yield the best possible postoperative refractive result. As the outcomes of
cataract surgery have improved, the use of lens surgery as a refractive modality in patients without
cataracts (clear lens extraction) has increased in popularity. The removal of the crystalline lens for refractive purposes, or so-called refractive lens exchange (RLE), offers distinct advantages over corneal
refractive surgery in selected cases. Nevertheless, in some middle-aged patients with high
refractive errors, corneal
refractive surgery can be a safe and effective treatment. In addition, the use of multifocal
lenses offers an alternative for the correction of
presbyopia. A further advantage of RLE is that it simultaneously eliminates the need for
cataract surgery in the future. The keys for success in RLE are effectiveness and consistency in the refractive outcome, providing at the same
time surgical and postoperative safety. To achieve these goals, adequate indications following strict risk/benefit criteria and refractive precision based on accurate preoperative protocols for IOL calculation and selection are mandatory, together with an appropriate choice of
surgical procedure based on the surgeon's skills, minimizing complications.