OBJECTIVE To evaluate the clinical outcomes of intraocular lens (IOL) exchange in patients with an opacified ACRL-C160 intraocular lens (IOL) using an optic-only removal technique. METHODS Department of Ophthalmology, Soonchunhyang University Hospital, Seoul, Korea. METHODS The study comprised eyes with previous phacoemulsification and implantation of a single-piece hydrophilic acrylic IOL in the capsular bag and subsequent development of severe late opacification of the IOL. In all eyes, the IOL optic was explanted; any haptic with firm adhesions was left in the capsular bag. This was followed by placement of a new IOL. The perioperative complications were evaluated, and the best corrected visual acuity (BCVA) before surgery and after surgery was compared. RESULTS Twenty-three eyes of 20 patients were evaluated. Uneventful IOL exchange and placement of a new IOL in the bag was achieved in 9 eyes (39.1%) and in the sulcus in 13 eyes (56.5%), with posterior capsule rupture in 2 eyes (8.7%). One eye (4.3%) developed zonular dehiscence, and scleral IOL fixation was performed. The mean BCVA was 0.64 +/- 0.35 logMAR before IOL exchange and 0.24 +/- 0.20 logMAR after IOL exchange. During 41 months of follow-up, 1 eye (4.3%) each was affected by recurrent anterior uveitis and delayed zonular dehiscence. The final mean BCVA was 0.38 +/- 0.40 logMAR. There was no corneal decompensation or infectious keratitis. CONCLUSIONS The optic-only removal technique was a safe and helpful procedure that allowed recovery of visual acuity because it decreased the intraoperative complication of zonular dehiscence.