Eyeworld

SEPTEMBER 2020 | EYEWORLD | 25 C IOL plunger by pressing a knob on the injector, giving it the same insertion feel of a twist type injector without the torque of manual thumb advancement, Dr. Vann said. This injector is not available in the U.S. though. What if the trailing haptic becomes trapped between the plunger and the cartridge? If the haptic becomes stuck to the optic? Dr. Davidson uses his non-dominant hand to stabilize the injector where the cartridge is mounted and takes his dominant hand and twists with a wiggle motion on the plunger as he's withdrawing the plunger, hoping to loosen the plunger from the optic. He doesn't come out of the eye with the injector. Dr. Davidson discussed what to do if the haptic is stuck to the optic. "A lot of surgeons will pinch the haptic with forceps, but this risks immediate flat chamber or use of additional OVD," he said. Dr. Davidson said he prefers to take the tip of the I/A needle and nudge the haptic in the plane of the optic peripherally, which usually breaks the adhesion. Dr. Vann hasn't often had a problem with a trailing haptic stuck to the plunger. If it gets stuck on the optic, he said the I/A handpiece can apply suction to the area of the haptic that's continued on page 26 Using a single-handed injector while fixating the globe with a second instrument provides excellent visualization of the anterior capsule leaflet, ensuring placement of the IOL in the bag during injection. Source: John Davidson, MD stuck to the optic. "That will often free it up to get it to expand and reshape itself to normal configuration," he said. If the haptic becomes trapped between the plunger and cartridge, Dr. Kim has used an internal approach with a second instrument through the sideport incision to bluntly tease the haptic off the plunger. If this doesn't work, he'll partially withdraw the injector to expose the stuck portion of the haptic, using forceps to free it. If the IOL is completely in the eye and the haptic is stuck to the optic, Dr. Kim's favorite technique is to use the I/A handpiece to gently push or lift the haptic off the optic. "I do this with the irrigation fluid turned on since it's eas- ier to manipulate a firm globe," he said. If this doesn't work, a second instrument with the I/A tip can apply opposing forces. With the I/A tip, he lifts up from under the haptic and pushes down on the optic with the cannula. How do you avoid IOL trauma? To avoid trauma to the IOL, for preloaded injectors, Dr. Vann said to make sure to use a lot of viscoelastic in the cartridge before advancing. Before the plunger meets the haptic,

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