Techniques%20for%20Using%20and%20Removing%20High-Viscosity%20OVDs%20in%20Cataract%20Surgery%20with%20Premium%20IOLs

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Techniques for Using and Removing High-Viscosity
OVDs in Cataract Surgery with Premium IOLs

• Rosa Braga-Mele, M. Ed, M.D., FRCS(S)
• Associate Professor, University of Toronto,
  Canada
• Director of Cataract Unit and Surgical
  Teaching,Mount Sinai Hospital, Toronto

Consultant for AMO, BL, and Alcon
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Purpose

• To evaluate the effects of a hight molecular
  weight, high-viscosity, viscoadative OVD (Healon
  5) in cataract surgery in normal eyes implanted
  with multifocal IOLs
• Healon 5 has been traditionally used in more
  challenging cases such as floppy iris syndrome,
  shallow chambers or small pupils due to its
  ability to compartmentalize and keep the iris at
  bay

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Methods

• 25 patients, age range 59-70, 15 male, 10 female,
  2-3 NS
• refractive IOL candidates and motivated
• No ocular pathology
• All cases used Healon 5 as viscoelastic
• All cases utilized Burp and Wiggle technique
  plus rock and roll1 of IOL for viscoelastic
  removal

1. 1st described by Dr. S. Arshinoff
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Burp and Wiggle Technique

• Burping occurs twice during procedure
• Removal of approx. 50 of viscoelastic by
  pressing on lip of incision
• Before hydrodissection
• Aids in fluid wave and helps prevent any
  potential posterior capsule rupture
• After IOL insertion
• Helps fracture viscoelastic and creates space for
  BSS to circulate and remove OVD

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Burp and Wiggle Technique

• Wiggle of I/A tip with removal of OVD further
  aids in fracture and eases removal
• Rock and roll of IOL
• Gently pushing IOL from side to side to help
  viscoelastic removal from behind the IOL without
  actually needing to go behind it

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Results Intraop

• Healon 5 used as OVD
• Facilitated smooth, consistent 5.0-5.5 mm
  capsulorhexis that was well-centred
• Cortical cleavage hydrodissection (Fine) easily
  performed with technique
• No complications
• All patients received either Rezoom MFIOL (23) or
  ReStor MFIOL (2)
• OVD successfully removed at end of case

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Results Post op 4-24 hrs

• 100 IOP Normal (15-20 mm Hg)
• 100 clear corneas
• UCDVa 20/25-20/40
• UCNVa J1-J3
• No patient complaints

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Conclusions

• Technique described aids in safe usage and
  complete removal of viscoadaptive OVD as
  evidenced by no intraoperative complications and
  no post-operative IOP spikes and clear corneas
• Healon 5 is safe and effective in producing
  consistent rhexis size and shape, reducing tears
  and helps protect the corneal endothelium with
  rapid visual recovery