EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
Issue link: https://digital.eyeworld.org/i/78710
May 2012 Anterior segment grand rounds DUOVISC® Viscoelastic System is designed to give two viscoelastic materials with different physico- chemical properties that can be used differently and/or sequentially to perform specific tasks during a cataract procedure. DUOVISC® of VISCOAT® Viscoelastic System consists PROVISC® Ophthalmic Viscosurgical Device and Ophthalmic Viscosurgical Device. CAUTION: Federal law restricts this device to sale by or on the order of a physician. VISCOAT® OVD (Sodium Chondroitin Sulfate – Sodium Hyaluronate) Ophthalmic Viscosurgical Device INDICATIONS: VISCOAT® OVD is indicated for use as an ophthalmic surgical aid in anterior segment procedures including cataract extraction and intraocular lens (IOL) implantation. Viscoat maintains a deep anterior chamber during anterior segment surgeries, enhances visualization during the surgical procedure, and protects the corneal endothelium and other ocular tissues. The viscoelasticity of the solution maintains the normal position of the vitreous face and prevents formation of a flat chamber during surgery. WARNINGS: Failure to follow assembly instructions or use of an alternate cannula may result in cannula detachment and potential patient injury. PRECAUTIONS: Precautions are limited to those normally associated with the surgical procedure being performed. Although sodium hyaluronate and sodium chondroitin sulfate are highly purified biological polymers, the physician should be aware of the potential allergic risks inherent in the use of any biological material. ADVERSE REACTIONS: VISCOAT® OVD has been extremely well tolerated in human and animal studies. A transient rise in intraocular pressure in the early postoperative period may be expected due to the presence of sodium hyaluronate, which has been shown to effect such a rise. It is therefore recommended that Viscoat be removed from the anterior chamber by thorough irrigation and/or aspiration at the end of surgery to minimize postoperative IOP increases. Do not overfill anterior chamber. ATTENTION: Reference the Physician Labeling/Directions for Use for a complete listing of indications, warnings and precautions. PROVISC® OVD (Sodium Hyaluronate) Ophthalmic Viscosurgical Device INDICATIONS: ProVisc® OVD is indicated for use as an ophthalmic surgical aid in the anterior segment during cataract extraction and intraocular lens (IOL) implantation. Ophthalmic viscoelastics serve to maintain a deep anterior chamber during anterior segment surgery allowing reduced trauma to the corneal endothelium and surrounding ocular tissues. They help push back the vitreous face and prevent formation of a flat chamber during surgery. PRECAUTIONS: Postoperative increases in intraocular pressure have been reported with sodium hyaluronate products. The IOP should be carefully monitored and appropriate therapy instituted if significant increases should occur. It is recommended that PROVISC® OVD be removed by irrigation and/or aspiration at the close of surgery. Do not overfill anterior chamber. Although sodium hyaluronate is a highly purified biological polymer, the physician should be aware of the potential allergic risks inherent in the use of any biological material; care should be used in patients with hypersensitivity to any components in this material. Cannula assembly instructions should be followed to prevent patient injury. ADVERSE REACTIONS: Postoperative inflammatory reactions such as hypopyon and iritis have been reported with the use of ophthalmic viscoelastics, as well as incidents of corneal edema, corneal decompensation, and a transient rise in intraocular pressure. ATTENTION: Reference the Physician Labeling/Directions for Use for a complete listing of indications, warnings and precautions. ELP needs a little HELP by Steven G. Safran, M.D. T his is a 64-year-old woman who pre- sented for a second opinion. She had cataract surgery a few months earlier in the right eye with implantation of a Tecnis Multifocal lens (Abbott Medical Optics, AMO, Santa Ana, Calif.). This was combined with an endocyclophotocoagulation (ECP) treatment for her glaucoma. Apparently during the ECP treatment an iatrogenic zonular dialysis occurred, and the surgeon decided to place a CTR to stabilize the lens. He then performed a YAG capsulotomy on this eye, which the patient felt "made no difference." She presented to me unhappy with the vision in the OD and with a cataract in the OS. She is left eye dominant. Steven G. Safran, M.D., ASGR editor O n examination the pa- tient's OD was 20/60 un- corrected with a Tecnis Multifocal in the capsular bag. Her left eye was 20/200-1 correcting to 20/40 with –3.25, the vision limited by a nu- clear sclerotic/posterior subcapsular cataract. There was an open poste- rior capsule after her YAG capsulo- tomy. She refracted with +1.0 sphere in this eye to 20/20-1. When I put this in a trial frame she noticed a big improvement but still felt that her vision was not quite as good as she would like. She had a Krukenberg spindle, iris transillumination de- fects, and pigment in the angle in the OD greater than the OS (the pig- ment is more dense superiorly than inferiorly, evidence of old "burnt out" PDS). Her IOP is 19 OD and 16 OS, and she is using Cosopt (dorzo- lamide/timolol, Merck, Whitehouse Station, N.J.) OS only and Lotemax (loteprednol etabonate ophthalmic suspension 0.5%, Bausch + Lomb, Rochester, N.Y.) OD QID. In the OD she had a Tecnis Watch this video on your smartphone or iPad using your QR code reader. (Scanner available for free at your app store.) Or view the video of Dr. Safran's procedure at youtu.be/Ty5jXeA8Rhc We want your cases! Have a particularly interesting anterior segment case you'd like to share with ASCRS colleagues? Send it to Dr. Safran for consideration as a "case of the month" for the ASGR column. Please contact him at safran12@comcast.net Multifocal in the bag. There was a large zonular dialysis from 2:00-6:00 with vitreous prolapse through the dialysis and into the anterior cham- ber with strands crossing the front of her implant and adherent to her temporal cataract incision (Figure 1). The CTR was visualized on gonioscopy, and there was a large gap between the equator of the bag and the ciliary body with pseudophakodonesis elicited by taping the eye (Figure 2). Her macula OCT was completely normal OU as was her VF test. Her OCT of the optic nerve showed some superionasal thinning of the NFL, but her OS was normal (Figures 3, 4, 5, and 6). It should be noted that when I put the +1.0 sphere in front of her right eye she felt that the vision was much improved but that the near point was too close for her computer work. I consulted a panel of Brian Kim, M.D., Professional Eye Associ- ates, Dalton, Ga.; Jeff Whitman, M.D., Key-Whitman Eye Center, Dallas; Jeff Horn, M.D., Vision for Life, Nashville, Tenn.; and Bill Myers, M.D., assistant professor of clinical ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago; to get some thoughts on how they would approach this patient. Most of the panel felt that tackling the left eye first would be a good initial step and that glaucoma surgery would not need to be considered here. Roundtable discussion Dr. Whitman commented, "I do not see glaucoma in the OS so certainly no ECP needed. Treat like the normal eye that it is and consider a Crystalens [Bausch + Lomb]. I would not gamble that she will love a multifocal in this eye." Dr. Kim commented, "It sounds like she wants to get rid of her ani- sometropia more urgently. You could offer her phaco with a pre- mium IOL for OS. I would choose a ReSTOR [Alcon, Fort Worth, Texas] since she complains of the near point being too close with the Tecnis." Dr. Myers commented: "I would consider getting the left eye surgery Figure 1. Note the vitreous strand seen at the border of the first ring traversing across the optic to the temporal incision and the open posterior capsule © 2011 Novartis 11/11 VIS11628JAD-PI Figure 2. Note the CTR in the equator of the bag and the gap due to the zonular dialysis