Cataract Surgery Feature Story

OCTOBER 2010 CATARACT & REFRACTIVE SURGERY TODAY EUROPE 39 T he viscous and elastic properties of ophthalmic viscosurgical devices (OVDs) have numerous benefits in cataract surgery. Not only can they create and maintain space in the anterior chamber, but they can also protect and lubricate the corneal endothelium and displace and stabilize tissue. Most surgeons do not think twice about using an OVD to aid in capsulorrhexis creation, phacoemulsification, and IOL insertion. However, after lens implantation, it is mandatory to thoroughly remove the OVD from the anterior chamber and from behind the IOL optic. If left in the eye, the OVD may induce a postoperative spike in intraocular pressure (IOP).1-2 Additionally, if the surgeon fails to remove OVD from the capsular bag, capsular bag distension syndrome may result.3 Many surgeons shy away from placing the I/A tip behind the IOL optic during cortical clean-up because of the risk of posterior capsular rupture. Additionally, small incision sizes, which today can vary from 1.8 to 1.6 mm with some lenses, make it hard to completely remove the OVD from behind the IOL. Therefore, I have begun implanting one-piece foldable acrylic IOLs without an OVD, using a technique that I call hydroimplantation.4