EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
Issue link: https://digital.eyeworld.org/i/407647
25 EW NEWS & OPINION November 2014 Nasal & Temporal Speculums 3360 Scherer Drive, Suite B, St. Petersburg, FL 33716 800-637-4346 • Tel: 727-209-2244 • Fax: 727-341-8123 Email: Info@RheinMedical.com • Website: www.RheinMedical.com *Developed In Coordination with Reay H. Brown, M.D. ** Developed In Coordination With Roger F. Steinert, M.D. Leonardo Da Vinci, Unnamed ADBC 1339 Rev.A Call 727-209-2244 For More Information. Special Fenestrated Blades Improve Exposure And Access To Superior Surgical Approaches By Supporting & Elevating The Middle Of The Lids As Seen In The Following: Figure 1, Temporal Blades With Drape. Figure 2, Temporal Blades Without Drape. F i g u re 2 F i g u re 1 08 -08164 : Brow n* T ri p le Post Specul um , Stai nless 05 -7105 : Br o wn* T ri ple P ost S peculum, T ita n iu m 08-08164 -S: St eine rt * *-B rown* Triple Post Specul u m , Nasal, S tainless 05-7105-T: Steinert**-B row n* T ri ple Post Specu lu m , Nasal, T itan iu m VIDEO "I will use a dollop of Viscoat in the center almost in a donut configuration, as described by Steve Arshinoff, MD, and Bob Osher, MD, originally, because the Viscoat, being dispersive, doesn't come out of the eye as quickly as the Healon 5," Dr. Braga-Mele explained. In a case involving a very dense nucleus, she stressed that it is important to use a dispersive viscoelastic such as Viscoat or EndoCoat (AMO). "What's im- portant with a dense nucleus is to make sure that you reinsert the viscoelastic. If you're dealing with something that is very dense like a 4+ brunescent cataract, you want to make sure that you continuously coat the endothelium throughout the procedure, thereby protecting it and minimizing corneal edema and maximizing visual outcomes," Dr. Braga-Mele said. If Dr. Miller is facing a rock-hard lens where he knows he is going to need the protective effect of a dispersive agent, instead of using his mainstay DisCoVisc, he will use a soft-shell technique. For this he uses Viscoat to protect the cornea and the cohesive agent Healon GV to maintain space. "Oftentimes I'll have to refill the eye several times with Viscoat, the dispersive, just to keep a layer up against the endothelium," Dr. Miller said. "If you spend a lot of time in there, you'll have fluid flow that will slowly wash the OVD out of the eye, so you'll have to keep topping it off." On the other end of the spec- trum, practitioners worry about ul- timately removing viscoelastic from the eye. However, Dr. Miller thinks the time may be coming when prac- titioners will have fewer concerns about this. He said that industry has been considering the possibility of an agent that practitioners would not have to worry about removing. Another possibility might be to have a substance available that could break down any remaining hyaluronic acid at the end of the case without destroying the eye, Dr. Miller said. He also sees a day coming when systems will allow for most of the steps of cataract removal without viscoelastic. "The ideal situation would be if we didn't have to use viscoelastic in the first place, then we wouldn't have to take it out," Dr. Miller said. With femtosecond laser technology a capsulorhexis can be created under fluid, he pointed out. "You don't open up the eye. You make the opening in the capsule in aqueous and go in and start the pha- co," Dr. Miller said. He can imagine a situation where practitioners take the cortex out and rather than filling the eye with viscoelastic, there is a system whereby the lens is pumped in while fluid is infused around it at the same time. This again would leave no viscoelastic to worry about in the end. For now, Dr. Braga-Mele said that viscoelastics are essential to the phaco process. "They're very import- ant in compartmentalizing, in pupil manipulation, in capsulorhexis formation, and in IOL insertion," she said. "It's always good to have an armamentarium of different types of viscoelastics because each one has its special place and helps you deal with the case in a more efficient manner." EW Editors' note: Drs. Braga-Mele and Miller have financial interests with Alcon. Contact information Braga-Mele: rbragamele@rogers.com Miller: kmiller@ucla.edu