This study evaluates the role of intraocular lens exchange procedures in the management of major implant-related complications. Medical records of 30 patients undergoing intraocular lens exchange at the Leeds General Infirmary from 1 January 1984 to 30 November 1991 were reviewed. Details of their primary implantation surgery, intervening ophthalmic history, lens exchange surgery and outcome were analysed. Follow-up ranged from 3 to 210 weeks. Seventy-six per cent of cases achieved final visual acuity of 6/12 or better. Visual acuity improved in 60%, worsened in 6.6% and was unchanged in 33.4% compared with pre-operative levels. Three patients had cystoid macular oedema, 3 ocular hypertension, 2 bullous keratopathy, 1 chronic anterior uveitis and 1 patient developed a retinal detachment. This approach to managing major implant-related complications gives good visual results. There is a significant complication rate but the risk-benefit ratio justifies the use of the technique.