Empty-bag technique for acrylic intraocular lens implantation using Healon5

Intraocular lens implantation without the use of ophthalmic viscosurgical device

The purpose of this study was to determine whether single-piece hydrophilic acrylic intraocular lens can be safely implanted without the use of ophthalmic viscosurgical devices. This retrospective study comprised 100 eyes having phacoemulsification and intraocular lens implantation without the use of ophthalmic viscosurgical device. 80 eyes with the use of a viscosurgical device are used as control group. In this intraocular lens implantation technique, the anterior chamber was maintained with an irrigation cannula and intraocular lens was implanted with a lens injector. Visual acuity, corneal clarity and edema, intraocular pressure, and corneal endothelial cell count were evaluated preoperatively and postoperatively at days 1, 7, and 30. Corneal endothelial cell count was repeated 2 weeks after surgery. Complications of this technique were also evaluated. No significant complications of this intraocular lens implantation technique, such as posterior capsule rupture, intraocular lens buttonholing, zonular dialysis, Descemet's tear/detachment, occurred. On the seventh postoperative day, 90 % of eyes achieved 20/20 or better vision. There was no difference in corneal endothelial cell loss between viscoelastic device-used and not-used cases (p = 0.356). When implanting intraocular lens without the use of ophthalmic viscosurgical device, significant intraoperative complications did not occur. The possible advantages are shortened surgery time, avoidance of postoperative IOP spike from ocular viscosurgical device (OVD) remnant, and reduced cost.

Use of viscoelastic substance in ophthalmic surgery - focus on sodium hyaluronate

Among viscoelastic substances, sodium hyaluronate has become the most popular for intraocular surgeries since the introduction of Healon^® (sodium hyaluronate 1%, 4 × 10⁶ daltons) in 1979. This review focuses on the recent development of a new generation of sodium hyaluronate agents with new rheologic properties and the relevant new techniques used in cataract, glaucoma, corneal, and vitreoretinal surgeries. The introduction of sodium hyaluronate agents with different rheologic properties has improved the safety and reliability of intraocular surgeries. Although there have been numerous studies reporting the effectiveness of viscoelastic substances in intraocular surgeries, rigorous validation by multi-center randomized control trials is lacking in many cases. At present, no single viscoelastic agent is most suitable to all of the various intraocular surgical techniques. Therefore, ophthalmologic surgeons should keep up with recent developments of viscoelastic agents and relevant surgical techniques for better patient care.

Adjunct devices for managing challenging cases in cataract surgery: capsular staining and ophthalmic viscosurgical devices

PURPOSE OF REVIEW

Cataract surgeons should employ all reasonable technology to facilitate safe and consistent outcomes. Knowledge of adjunct devices to enhance visualization of the capsular bag and appropriate use of ophthalmic viscosurgical devices allow for enhanced protection of intraocular structures and reduced rates of complication.

RECENT FINDINGS

Trypan blue is US Food and Drug Administration-approved for facilitating visualization of the anterior capsule. Animal data demonstrate Brilliant Blue G to be an effective capsular stain with a superior safety profile. Healon5 is a safe viscosurgical device that is particularly useful in children, poorly dilating pupils, intraoperative floppy-iris syndrome, and intumescent cataracts. The viscoadaptivity of Healon5 enables its utility throughout the procedure of cataract extraction. The recent literature on capsular dyes and advances in ophthalmic viscosurgical technology is reviewed.

SUMMARY

Inadequate capsular visualization and poor tissue stabilization/protection increase the chance of discontinuous capsulorhexis, retained nuclear material, vitreous loss and corneal decompensation. Utilization of adjunctive tools in the setting of challenging cataract cases can significantly limit adverse intraoperative outcomes and result in reproducible surgical success.