Eyeworld

NOV 2014

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

Issue link: https://digital.eyeworld.org/i/407647

Contents of this Issue

Navigation

Page 26 of 90

EW NEWS & OPINION 24 November 2014 by Maxine Lipner EyeWorld Senior Contributing Writer be a good space maintainer," he said. In addition, when you have 2 vials available, there is a lot of viscoelastic available for use. "One of the biggest complaints physicians have is that they run out of visco- elastic and have to open a second vial, and it's very expensive to do that," Dr. Miller said. "DuoVisc is popular because you get so much of it, you don't generally have to go to a second package." Rosa Braga-Mele, MD, professor of ophthalmology, University of Toronto, favors DuoVisc. She likes the fact that she has both a dis- persive and a cohesive viscoelastic at her disposal. "I'll use Viscoat at the beginning of the case to coat the corneal endothelium—it's a dispersive viscoelastic and it stays in the eye well and protects the endothelium and compartmental- izes well," Dr. Braga-Mele said. "So during capsulorhexis formation and phacoemulsification, I prefer to use a dispersive viscoelastic to protect the cornea." However, once Dr. Braga-Mele removes all of the cortex and inserts the IOL, she uses the cohesive ProVisc OVD, which offers ease of removal at the end of the case. This is especially useful in cases where she is using a toric or a multifocal lens; here she would particularly like to make sure that all of the viscoelastic is out from behind the lens so that it sits well in the capsular bag. More challenging slight-of-hand In more difficult cases, Dr. Braga-Mele takes a slightly different approach. In these cases, she uses a combination of Healon 5 (AMO) and Viscoat. "I'll use Healon 5 for things like [intraoperative floppy iris syndrome] or small pupil cases," she said. "Being a viscoadaptive agent, it's a bit heavier and it will sit on the iris and keep the iris out of the way for the procedure." In such challeng- ing cases, she will layer the Healon 5 on top of the iris so that it pushes the iris to the side, then she will add Viscoat. What practitioners use to make lenses disappear U sing a dollop here and there of viscoelastic, practitioners seem to be able to make cataract lenses vanish effortlessly during phacoemulsification. From DisCoVisc (Alcon, Fort Worth, Texas) to Healon GV (Abbott Medical Optics, AMO, Santa Ana, Calif.) and beyond there are a panoply of choices to make the phaco "trick" go off without a hitch. Here are some of the viscoelastic picks practitioners are making. Old favorites Kevin Miller, MD, finds that while all viscoelastics work reasonably well, they have their pluses and minuses. "My workhorse viscoelastic agent right now is DisCoVisc," Dr. Miller said. "It has combination dispersive and cohesive properties." Prior to this, Dr. Miller had been using Healon GV as his agent of choice, which he also found worked well. But when DisCoVisc came out, he opted to give it a try. "I com- pared before and after for a bunch of patients," he said. "Even though the DisCoVisc was much harder to get out of the eye than Healon GV, the corneas looked better the next day with DisCoVisc, so I thought 'I'll suffer the aggravation of trying to get this stuff out because patients saw a little better and were happier the next day.'" However, he pegs DuoVisc (Alcon) as the most popular OVD in the U.S. This contains separate vials of the cohesive ProVisc and the dispersive Viscoat, giving prac- titioners options for the beginning of the procedure and the end, Dr. Miller explained. "A lot of people want the dispersive protecting the corneal endothelium when they're doing the phaco part, and when they're ready to put the lens implant in, they want something that's going to Viscoelastic bag of tricks In addition to selecting the best OVD for a particular patient, using a proper injection technique for viscoelastic is paramount. The cannula should be positioned across the anterior chamber before the injection is begun. Otherwise, air and aqueous humor will get trapped inside the eye. Source: Kevin M. Miller, MD

Articles in this issue

Archives of this issue

view archives of Eyeworld - NOV 2014