EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
Issue link: https://digital.eyeworld.org/i/1282091
26 | EYEWORLD | SEPTEMBER 2020 ATARACT C look closely to make sure it's advancing in the proper plane so you're not kinking or traumatiz- ing the implant with the plunger advancing over top or down below the optic, he added. Inside the eye, once you've injected it, Dr. Vann tries to have his second instrument away from the optic. Dr. Davidson said he rou- tinely checks the folding forceps under the microscope to make sure they don't have any metal burrs on them that could scratch the lens. He instructs technicians to never handle the optic. It's nec- essary to touch the optic when folding it in the cartridge, but when pulling it out of the case and handling it any other time, grab by the haptics, he said. How do you insert a single-piece acrylic IOL with an anterior capsular tear? Would you put in a single- piece with a posterior capsule tear? It is safe to place a single-piece acrylic IOL in a bag with an isolated anterior capsule tear, Dr. Kim said. The key is to rotate the haptics within the bag so they are perpendicular to the tear, ensuring the IOL remains well centered. In-the-bag single-piece acrylic IOLs should be avoided in the setting of posterior capsule tears for any defects bigger than the IOL optic. They should also be avoided in bags with any sized pe- ripheral posterior capsule defect since the haptic can slip through the defect and lead to IOL dislocation. Small, fairly central posterior capsule tears can safely hold a single-piece acrylic IOL. "An even better strategy would continued from page 25 A second instrument is placed through the sideport incision 90 degrees away from the main incision to stabilize the eye as the IOL injector is inserted. The I/A tip is slid under the optic, which is tilted and rotated 90 degrees within the capsular bag. This maneuver enables direct evacuation of all the OVD from within the capsular bag and ensures both haptics are within the capsular bag. Source (all): D. Brian Kim, MD Under continuous irrigation, the I/A tip is positioned slightly under the optic-haptic junction in order to lift and push the stuck haptic off the optic.