Removal of an ophthalmic viscoelastic device

Abstract

In the May 2000 issue, Durak and Oner1 describe a useful clue for complete removal of an ophthalmic viscoelastic device (OVD) during phacoemulsification. Similar intraoperative posterior capsule striae were described by Vasavada and Trivedi2 in 56% of cases that had phacoemulsification with foldable intraocular lens (IOL) implantation. They attribute the occurrence of intraoperative posterior capsule striae to the disparity in size between the IOL and capsular bag. Following OVD aspiration after IOL implantation, we have also seen a line parallel to the longitudinal axis of the IOL appear in the posterior capsule, indicating that OVD between the IOL optic and the posterior capsule has been completely removed from the bag. We use AcrySof® lenses (Alcon Laboratories) and sodium hyaluronate (Healon GV®) routinely, and this phenomenon may occur more often with this combination. As soon as the line appears, one must become very cautious because this striae denotes capsular bag distortion. The irrigation/aspiration (I/A) probe should be immediately withdrawn in the irrigation mode, with the aspiration port facing anteriorly since the capsular bag becomes loose and inadvertent posterior capsule capture may occur at this juncture. If the I/A probe is in the aspiration mode during withdrawal of the probe, an inadvertent posterior capsule tear may occur. We would like to highlight additional clues for complete removal of an OVD during phacoemulsification. The OVD should be removed from behind the IOL by placing the I/A probe between the IOL optic and the posterior capsule, with the aspiration port of the I/A probe facing anteriorly. Healon GV has a higher refractive index than enriched balanced salt solution. Thus, duality is created between the 2 and the Healon GV bolus can be seen being aspirated and also exiting the incision. Remove Healon GV from over the IOL, again with the port of the I/A probe facing anteriorly. The jerky movements of the IOL are observed following complete OVD removal, which was muffled earlier due to the tamponade effect of the OVD. Thus, the viscoelastic has to be removed from the anterior as well as the posterior chambers of the eye to offset the compartmentalization induced by the presence of the IOL. The above maneuvers help to remove the OVD completely and prevent secondary postoperative intraocular pressure spikes as well as postoperative capsular distension syndrome. Namrata Sharma MD Tanuj Dada MD Vijay K Dada MBBS, MS aNew Delhi, India