Removal times and techniques of a viscoadaptive ophthalmic viscosurgical device

Abstract

Purpose: To analyze removal techniques for Healon ®5 (sodium hyaluronate 2.3%). Setting: Center for Research on Ocular Therapeutics and Biodevices, Charleston, South Carolina, USA, and Department of Ophthalmology, Ruprecht-KarlsUniversity, Heidelberg, Germany. Methods: In a standardized laboratory setup, the Miyake-Apple posterior view video technique in human autopsy eyes was used to evaluate removal of an ophthalmic viscosurgical device (OVD) from capsular bags implanted with poly(methyl methacrylate), silicone, and acrylic intraocular lenses (IOLs). Healon5 was stained with fluorescein for better visualization. Open-sky preparation and an Alcon Legacy ® Series 20000 ® phaco machine with a flow rate of 25 mL/minute and a vacuum setting of +500 mm Hg (maximum irrigation/aspiration [I/A]) were used. With Technique 1, the I/A tip was placed on the center of the IOL and maximum aspiration was applied. With Technique 2 (modified rock 'n roll technique), the I/A tip was moved in quick circular movements on top of the IOL to break the OVD chains and facilitate aspiration. Results: With Technique 1, the mean removal time was 59.0 seconds ± 23.1 (SD) and with Technique 2, 23.6 ± 10.3 seconds ( P = .004). The removal time of Healon5 correlated with the IOL material. With Technique 2, removal was fastest with silicone IOLs (13.5 ± 2.1 seconds) followed by PMMA IOLs (17.5 ± 2.1 seconds). With acrylic IOLs, remnants of the OVD trapped behind the IOL optic resulted in a longer removal time of 34.1 ± 1.2 seconds. Conclusions: Healon5 was completely removed from the capsular bag with the modified rock 'n roll technique. With acrylic IOLs, remnants can be trapped behind the optic and may be overlooked with an unstained OVD. Aspiration behind the optic is recommended with this IOL type.