JAN 2013

EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.

Issue link: https://digital.eyeworld.org/i/104833

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January 2013 of that to open up the space to perform the surgery." Together these each work to their best advantage, Dr. Blomquist finds. The viscoadaptive bridge A final category of OVDs that can prove helpful in complex cases is viscoadaptive agents, such as Healon5 (AMO), which has characteristics of cohesives and is also pseudodispersive under high flow conditions. "Healon5 is called viscoadaptive because under some conditions it can actually changes its rheologic behavior," Dr. Arshinoff said. "Under high flow conditions it behaves as a solid, so it starts to fracture apart." This makes it a pseudodispersive. Likewise, when stationary, Healon5 is exceedingly viscous, like a cohesive, good for maintaining anterior chamber depth. One of the strengths of viscoadaptives, Dr. Arshinoff stressed, is this viscosity. "They are so viscous they don't allow water to leak through them," he said. "So you can use balanced salt as a second OVD because the viscoadaptive isolates it and does not mix with it." The viscoadaptive OVD can be used to block the incision, with a solution of lidocaine and phenylephrine serving in place of balanced salt in the style of the "ultimate soft shell." This solution causes excellent dilation of the pupil and makes the procedure easier. When in need of a viscoadaptive, Dr. Arshinoff favors Healon5, which he terms the prototype. Overall, Dr. Arshinoff encourages practitioners to look at each case as if it were involving physically separable spaces rather than a single surgical space, keeping in mind the different OVD properties. If a practitioner keeps three or four OVDs on hand, this can make it easier to deal with complex cases. "Almost all of them end up being quite simple because you have rigged the game for yourself like a card player who rigs the cards before he plays," he said. "If you rig the game before you start, things that appeared very difficult really aren't hard at all." EW Editors' note: Dr. Arshinoff has financial interests with Alcon, AMO, and Bausch + Lomb and has consulted for all of the OVD companies. Dr. Blomquist has no financial interests related to this article. Dr. Henderson has financial interests with Alcon and Bausch + Lomb. Dr. Steinert has financial interests with AMO. Contact information Arshinoff: 416-745-6969, ifix2is@sympatico.ca Blomquist: 214-648-3770, preston.blomquist@utsouthwestern.edu EW CATARACT 27 Henderson: 617-723-2015, bahenderson@eyeboston.com Steinert: 949-824-0327, steinert@uci.edu

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