Ophthalmic Viscosurgical Device Removal Research Articles

Comparison of the Residual Amount of an Ophthalmic Viscosurgical Device Among Different Types of Intraocular Lens Implants in vitro.

Although ophthalmic viscosurgical devices are quite important for safe cataract surgery, currently, postoperative residual ophthalmic viscosurgical devices can cause various complications. Previously, we developed a method to visualize residual ophthalmic viscosurgical devices after irrigation/aspiration in vitro and found that the amount of residual ophthalmic viscosurgical device on a single-piece intraocular lens was greater than that on a three-piece intraocular lens. In the present study, we compared the amounts of residual ophthalmic viscosurgical device among various foldable intraocular lenses to investigate the factors that determine the quantity of residual ophthalmic viscosurgical device. Simulated cataract surgery was performed in pig eyes using an ophthalmic viscosurgical device labeled with fluorescent silica particles. After the simulated surgery procedure, the fluorescent silica attached to the intraocular lens was observed and quantified by inductively coupled plasma-atomic emission spectrometry after intraocular lens removal. The amount of residual ophthalmic viscosurgical device was compared among five representative single-piece intraocular lenses and one three-piece intraocular lens. The distribution and amount of the residual ophthalmic viscosurgical device differed for each intraocular lens. The amount of silicon in the lens capsule differed among the intraocular lens types. The postoperative residual tendency of ophthalmic viscosurgical devices differed among various single-piece intraocular lenses. The behavior of the intraocular lenses within the capsule affected the residual tendency. The removal of ophthalmic viscosurgical device in the lens capsule should be tailored for each intraocular lens to improve efficiency.

Simple Technique for Stabilizing Toric Intraocular Lens during Removal of Ophthalmic Viscosurgical Device

Introduction: The aim of this study was to describe a simple technique for the implantation of toric intraocular lenses (IOLs) with increased stability during ophthalmic viscosurgical device (OVD) removal. Methods: The technique was performed on 20 eyes with 20 patients (mean age: 77.9 ± 9.21 years). The patients had cataract surgery with implantation of a single-piece, acrylic IOL (AcrySof Toric IOL, SN6A; Alcon Laboratories, Inc.). The intraoperative IOL rotation during OVD removal, rotational error of toric IOL axis at 30 min and 24 h after surgery, and mean preoperative and postoperative IOP were evaluated. Images were captured before and after removal of OVD from surgical video, and used to evaluate intraoperative IOL rotation. Results: The mean amount of IOL rotation during OVD removal with the current technique was 0.88 ± 0.93°, which was less than the 10.25 ± 5.50° previously reported for the conventional technique. The rotational error of toric IOL axis at 30 min and 24 h were 3.90 ± 3.71 and 3.05 ± 3.22°, respectively. The mean preoperative IOP and postoperative IOP were 13.84 ± 2.39 and 14.15 ± 4.68 mm Hg, respectively. Conclusions: With the current technique, the toric IOL is stable during OVD removal and repositioning of the IOL during surgery is less likely to be required.

Ophthalmic viscosurgical device interaction with two hydrophobic acrylic intraocular lenses of different equilibrium water content

Ophthalmic viscosurgical device (OVD) is used during intraocular surgery to protect ocular tissue. It requires complete removal from the eye by the end of surgery to avoid postoperative complications. This study compares the interaction of a cohesive OVD with two different intraocular lenses (IOLs) of different equilibrium water content. In this laboratory study on porcine cadaver eyes, the capsular bags and anterior chambers of each eye were filled with fluorescein-stained OVD. Following implantation of 10 IOLs each of Clareon CNA0T0 and AcrySof SN60WF (Alcon Laboratory, Fort Worth, USA) IOLs, the OVD was removed using the irrigation/aspiration mode. The OVD removal was timed and differences between the both IOL groups were compared. OVD removal time ranged from 18 to 40 s (mean ± SD, 26.4 ± 6.8 s) and from 16 to 39 s (mean ± SD, 23.6 ± 6.6 s) for eyes implanted with a CNA0T0 and a SN60WF IOL, respectively, without a statistically significant difference between the groups, P > 0.05. Cohesive OVD removal times were similar between the CNA0T0 and SN60WF groups. Surgeons should experience no differences regarding the interaction between cohesive OVDs and IOLs made from the new Clareon material compared to the established AcrySof material.

Phacoemulsification with hydrodelineation and OVD-assisted hydrodissection in posterior polar cataract

BackgroundTo evaluate the results and complications of phacoemulsification with hydrodelineation and ophthalmic viscosurgical device (OVD)-assisted hydrodissection for posterior polar cataract (PPC).MethodsMedical records of 24 eyes from 17 patients with clinical diagnosis of PPC, who underwent phacoemulsification with hydrodelineation and OVD-assisted hydrodissection, were retrospectively reviewed.ResultsThe incidence of posterior capsule rupture (PCR) was 16.67% (4/24): 2 cases occurred during epinucleus removal, and 2 cases occurred during OVD removal after the implantation of the intraocular lens into the bag. No nucleus piece or lens materials dropped into the vitreous during cataract surgery, and no obvious postoperative complications were found during follow-up. All patients had improved best-corrected visual acuity (BCVA) 1 month postoperatively.ConclusionOVD-assisted hydrodissection could be an effective technique in phacoemulsification to reduce the incidence of PCR and achieve satisfactory postoperative outcomes.

Anterior subcapsular cataract caused by forceful irrigation during implantation of a posterior chamber phakic intraocular lens with a central hole

To report the rare entity of anterior subcapsular cataract after implantation of a posterior chamber phakic intraocular lens (pIOL) with a central hole. Department of Ophthalmology, Goethe-University, Frankfurt, Germany. Retrospective case series. Medical reports were reviewed of patients with vision loss caused by anterior subcapsular cataract after implantation of the V4c Visian Implantable Collamer Lens with a central hole. Patients were identified during regular follow-up visits between January and September 2015. Possible causative factors, such as microbial contamination of surgical instruments, type of ophthalmic viscosurgical device (OVD) and irrigation substance, intracameral application of mydriatics and antibiotics, duration of surgeries, and surgical technique were analyzed. Eleven eyes of 8 patients showed white opacification behind the anterior capsule of the crystalline lens 1day postoperatively. Opacification led to a significant loss of corrected distance visual acuity in all eyes. In 9 eyes, the pIOL was explanted and in 8 eyes, phacoemulsification with IOL implantation was performed. All other analyzed possible causative factors were excluded; thus, the opacification was attributed to the surgical technique of OVD removal by irrigation with a cannula in the presence of a central hole in the pIOL. After the surgical technique was adapted, no further cases of anterior subcapsular cataract occurred. Anterior subcapsular cataract was induced during implantation of a pIOL with a central hole by cannula irrigation with enforced stream onto the capsule through that hole. This entity can be avoided by a change in surgical technique.

Characterizing the learning curve in phacoemulsification

To characterize how residents learn phacoemulsification and determine which steps of the procedure are most difficult to master. University of Colorado Hospital, Aurora, Colorado, USA. Comparative case series. Cataract cases were divided into 3 levels of difficulty for comparison. Residents were given a grade for each step of the procedure by the attending surgeon. Main outcome measures were total case time and a proficiency grade. Independent variables were level of resident experience and degree of difficulty. Case times of attending cases were collected for comparison. Nine residents were evaluated by 4 attending surgeons while performing 324 cases of phacoemulsification. Case times of 319 attending cases were used for comparison. The easiest-to-learn steps (highest scores versus level of experience) included intraocular lens insertion, ophthalmic viscosurgical device removal, hydrodissection, and nucleus sculpting. Wound integrity, nucleus disassembly and removal, cortex removal, and capsulorhexis had the lowest scores versus level of experience. Resident case times decreased significantly with experience, approaching average case times for attendings. For this study, competency was defined as the ability of the resident to perform a case in a reasonable time without intervention or complication. Using this definition, competency was achieved when case experience exceeded 75 cataract surgeries. No author has a financial or proprietary interest in any material or method mentioned.

Comparison of OVD and BSS for Maintaining the Anterior Chamber during IOL Implantation

PurposeTo compare surgical results between conventional intraocular lens (IOL) implantation using an ophthalmic viscosurgical device (OVD) and IOL implantation using a balanced salt solution (BSS) after irrigation/aspiration (I/A) of the lens cortex.MethodsA randomized prospective study was conducted on 62 patients who underwent cataract surgery. Following completion of conventional I/A of the lens cortex, we divided patients into two groups according to whether or not BSS was used. In group A (n = 31), the anterior chamber and the capsular bag were completely filled with an OVD before IOL implantation. On the other hand, in group B (n = 31), BSS was irrigated into the anterior chamber through a previous side port during IOL implantation. Surgical results were compared between the two groups.ResultsIn both groups, IOP peaked six hours after surgery. The occurrence of an IOP spike by postoperative day one was observed in six cases (6 / 31) in group A and in no cases (0 / 31) in group B, a difference that was statistically significant (p = 0.024). The values of endothelial cell density, central corneal thickness, anterior chamber inflammation, myopic shift, and posterior capsule opacification were not significantly different between the two groups.ConclusionsCompared with the use of OVD for IOL implantation, use of BSS during IOL implantation resulted in reductions in postoperative IOP spike and OVD removal time.

Hydroimplantation: Foldable intraocular lens implantation without an ophthalmic viscosurgical device

I describe a technique for implantation of a 1-piece acrylic foldable intraocular lens (IOL) using an irrigation cannula of the phaco machine without using an ophthalmic viscosurgical device (OVD). The irrigating cannula introduced through a side port provides excellent stability and positioning to the eye; if required, the cannula tip is used to guide the leading haptic of the IOL into the capsular bag. The fluid coming from the side port via a bimanual irrigation cannula maintains adequate formation of the capsular bag and anterior chamber while the foldable IOL is inserted. The hydroimplantation technique has the advantage of increased efficiency, reduced surgical time and cost, no need for OVD removal from behind the IOL or for additional instrumentation, no OVD-induced intraocular pressure elevation postoperatively, and no risk of early capsular bag distension syndrome.

Rotational Stability of a Single-Piece Hydrophobic Acrylic Intraocular Lens During Removal of Ophthalmic Viscosurgical Devices

To compare the effect of cohesive and dispersive ophthalmic viscosurgical device (OVD) on intraoperative rotational stability of the intraocular lens (IOL) with single-piece hydrophobic acrylate platform. Prospective, comparative study. This institutional clinical study included 60 eyes of 60 patients who underwent phacoemulsifcation. The patients were equally divided into cohesive OVD (Healon GV; Abbott Medical Optics, Abbott Park, Illinois, USA) group and dispersive OVD (Viscoat; Alcon Laboratories, Fort Worth, Texas, USA) group. Image analysis from the captured digital image was used to measure intraoperative rotation of single-piece hydrophobic acrylate IOL (SA60AT or SA60NT) during OVD removal. Mean intraoperative rotation was 7.42 degrees +/- 4.16 (standard deviation) in dispersive OVD group and 13.08 degrees +/- 5.25 (standard deviation) in cohesive OVD group (P < .001). Twenty-one cases (70%) maintained the alignment within 10 degrees during removal of OVD with dispersive OVD, while only 9 cases (30%) did so with cohesive OVD (P = .005). Counterclockwise rotation was observed in 33% of the all cases. This study showed that a significant amount of IOL rotation occurred during OVD removal. Intraoperative rotational stability of IOL was greater with Viscoat than with Healon GV.

Surgical options in the face of positive pressure

Positive pressure during cataract surgery can adversely affect the clinical outcome if the surgeon is unprepared. A variety of surgical maneuvers are described, including dry insertion of the phacoemulsification needle, capsule protection with the second instrument, dry cortical aspiration in an ophthalmic viscosurgical device (OVD) environment, intraocular lens restraint with an injection cannula at the end of OVD removal, aspiration or vitrectomy through the pars plana, a technique of OVD clearance to manage extreme cases of positive pressure, and intraoperative ophthalmoscopy using a lens designed to function with the operative microscope. Mastery of these important surgical maneuvers will help the surgeon manage challenging cases of positive pressure.

Management of lens–iris diaphragm retropulsion syndrome

We read with keen interest the article on managing the lens–iris diaphragm retropulsion syndrome (LIDRS).1 Methods to relieve the block include lowering the bottle height to decrease the pressure gradient between the anterior and posterior chambers and mechanically separating the iris from the anterior capsule rim using the irrigation/aspiration probe, phaco tip, or any second instrument. We recently encountered several cases of LIDRS because of the many high myopes in our population. Using the technique described by Cionni and coauthors, we failed to relieve the negative pupil block despite sweeping the iris off the anterior capsule. We had to aspirate the ophthalmic viscosurgical device (OVD) over the iris in at least 1 quadrant before we succeeded in breaking the block. Loose zonules, 360-degree overlap of the anterior capsule and the iris, along with the mechanical push by the dispersive OVD contributed to the failure of the maneuver to relieve the LIDRS. Cionni and coauthors used the soft-shell technique with sodium hyaluronate 1.0% (Provisc) in the center and sodium hyaluronate 3.0%–sodium chondroitin sulfate 4.0% (Viscoat) in the periphery. While Provisc is easily removed at the start of phacoemulsification, Viscoat is left coating the endothelium and the iris periphery, making it easier to release the iris–anterior capsule apposition with manual manipulation alone. In our center, it is customary to use Viscoat alone during phacoemulsification. This dispersive OVD tends to push the iris posteriorly, plastering it against the anterior capsule where the capsulorhexis touches the undersurface of the pupil, thereby counteracting the maneuvers to separate the iris and the anterior capsule. The maneuver described by Cionni and coauthors may be useful for surgeons using the soft-shell technique, whereas the removal of OVD in at least 1 quadrant is necessary when dispersive OVDs such as Viscoat and hyaluronate 3.0% (Vitrax) are used. Soon Phaik Chee MBBS, FRCSG, MMed (Ophth), FRCSE Kristine Bacsal MD, DPBO Singapore

Empty-bag technique for acrylic intraocular lens implantation using Healon5

Purpose: To determine how often the empty-bag technique (EBT) for injecting an acrylic foldable intraocular lens (IOL) into the capsular bag using Healon®5 (sodium hyaluronate 2.3%) will require a 2-compartment technique to remove the ophthalmic viscosurgical device (OVD) and compare this with that of a standard injection method using Healon5. Setting: Cincinnati Eye Institute and Ambulatory Surgical Center, Cincinnati, Ohio, USA. Methods: Forty-one eyes of 40 patients were randomly assigned to 1 of 2 groups. In Group A, standard capsular bag expansion was performed with Healon5 before implantation of an acrylic posterior chamber (PC) IOL. In Group B, Healon5 was placed in the anterior chamber followed by balanced salt solution expansion of the capsular bag before acrylic PC IOL implantation. In all patients, complete OVD removal was attempted with the automated aspiration tip anterior to the optic (rock 'n roll technique). The number of patients in each group who required placement of the aspiration tip posterior to the optic for complete removal was compared. Early postoperative intraocular pressure (IOP) was also compared. Results: In Group A, 15 (75%) of 20 eyes required placement of the aspiration tip posterior to the optic for complete OVD removal and in Group B, 1 (0.05%) of 20 eyes. The postoperative IOP was similar in both groups. Conclusions: The EBT decreased the likelihood that a 2-compartment OVD removal method would be necessary when using Healon5 for acrylic PC IOL implantation. The limitations of this new technique must be fully understood before it is used.

Posterior capsule folds and removal of ophthalmic viscosurgical devices

Purpose To evaluate the relationship between posterior capsule folds and an ophthalmic viscosurgical device (OVD) during cataract surgery. Setting Parkland Memorial Hospital, Dallas, Texas, USA. Methods A prospective observational study of 91 consecutive uneventful cataract extractions by phacoemulsification was performed. The presence or absence of posterior capsule folds was noted immediately after intraocular lens (IOL) implantation and after OVD removal. Results Posterior capsule folds were present in 21 of 49 cases (43%) with an MA60BM lens (Alcon Laboratories) and in 1 of 42 cases (2%) with an SA30AL lens. In the MA60BM group with folds, the folds were noted before OVD removal in 14 cases and after OVD removal in 16 cases. There was no significant difference in age, sex, axial length, horizontal corneal diameter, or IOL power between groups with and without posterior capsule folds. Conclusion The presence of posterior capsule folds does not reliably signify the complete removal of OVDs.