Eyeworld

48 | EYEWORLD | DECEMBER 2020 Contact Name: email ATARACT C If the haptics are adherent and do not come free with OVD and dissection, Dr. Chee said to lift the optic out of the bag and cut out and remove the central third. You could also cut the optic in half, which allows you more room to attempt to free the IOL without stressing the zonules. Dr. Chee said she prefers to reposition or exchange a lens that is fully in the bag earlier rather than later (and before fibrosis sets in), but she would hardly consider any IOL too late to reposition or exchange. IOL refixation Dr. Rocha noted that if the lens still looks good and the patient has good vision, this is a scenar- io when you can plan to use the same lens and refixate it. If you're keeping the same lens, she said it's important to determine if the patient was able to see well before with this lens and them, as they do not stay still when attempting to iris fixate." She'll use serrated IOL forceps to grasp the IOL when cutting. "If you fail to hold the IOL firmly with your lens forceps, try the conjunctival forceps, which are serrated and will hold them firmly for explantation," Dr. Chee said. It's important to know the IOL you're explanting, where the positioning hole is or whether there is a knob at the end of the haptic, and what the IOL material is, Dr. Chee said. If you need to open the capsule and free the haptics, Dr. Chee recommended inserting the OVD cannula between the anterior capsule and the IOL anterior surface. Begin injecting the OVD, but if this is not possible, she said to use a micro-grasper to lift up the anterior capsule to allow the OVD cannula to slip between the an- terior capsule and IOL and inject the OVD. She said to avoid using graspers that have a sharp end, as the capsule may rip. AcrySof ® IQ PanOptix ® Family of Trifocal IOLs Important Product Information CAUTION: Federal (USA) law restricts this device to the sale by or on the order of a physician. INDICATIONS: The AcrySof ® IQ PanOptix ® Trifocal IOLs include AcrySof ® IQ PanOptix ® and AcrySof ® IQ PanOptix ® Toric IOLs and are indicated for primary implantation in the capsular bag in the posterior chamber of the eye for the visual correction of aphakia in adult patients, with less than 1 diopter of pre-existing corneal astigmatism, in whom a cataractous lens has been removed. The lens mitigates the effects of presbyopia by providing improved intermediate and near visual acuity, while maintaining comparable distance visual acuity with a reduced need for eyeglasses, compared to a monofocal IOL. In addition, the AcrySof ® IQ PanOptix ® Toric Trifocal IOL is indicated for the reduction of residual refractive astigmatism. WARNINGS/PRECAUTIONS: Careful preoperative evaluation and sound clinical judgment should be used by the surgeon to decide the risk/benefit ratio before implanting a lens in a patient with any of the conditions described in the Directions for Use labeling. Physicians should target emmetropia and ensure that IOL centration is achieved. For the AcrySof ® IQ PanOptix ® Toric Trifocal IOL, the lens should not be implanted if the posterior capsule is ruptured, if the zonules are damaged or if a primary posterior capsulotomy is planned. Rotation can reduce astigmatic correction. If necessary, lens repositioning should occur as early as possible prior to lens encapsulation. Some visual effects may be expected due to the superposition of focused and unfocused multiple images. These may include some perceptions of halos or starbursts, as well as other visual symptoms. As with other multifocal IOLs, there is a possibility that visual symptoms may be significant enough that the patient will request explant of the multifocal IOL. A reduction in contrast sensitivity as compared to a monofocal IOL may be experienced by some patients and may be more prevalent in low lighting conditions. Therefore, patients implanted with multifocal IOLs should exercise caution when driving at night or in poor visibility conditions. Patients should be advised that unexpected outcomes could lead to continued spectacle dependence or the need for secondary surgical intervention (e.g., intraocular lens replacement or repositioning). As with other multifocal IOLs, patients may need glasses when reading small print or looking at small objects. Posterior capsule opacification (PCO) may significantly affect the vision of patients with multifocal IOLs sooner in its progression than patients with monofocal IOLs. Prior to surgery, physicians should provide prospective patients with a copy of the Patient Information Brochure, available from Alcon, informing them of possible risks and benefits associated with the AcrySof ® IQ PanOptix ® Trifocal IOLs. ATTENTION: Reference the Directions for Use labeling for each IOL for a complete listing of indications, warnings and precautions. continued from page 46

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