EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
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March 2012 Device focus DUOVISC® Viscoelastic System is designed to give two viscoelastic materials with different physico- chemical properties that can be used differently and/or sequentially to perform specific tasks during a cataract procedure. DUOVISC® of VISCOAT® Viscoelastic System consists PROVISC® Ophthalmic Viscosurgical Device and Ophthalmic Viscosurgical Device. CAUTION: Federal law restricts this device to sale by or on the order of a physician. VISCOAT® OVD (Sodium Chondroitin Sulfate – Sodium Hyaluronate) Ophthalmic Viscosurgical Device INDICATIONS: VISCOAT® OVD is indicated for use as an ophthalmic surgical aid in anterior segment procedures including cataract extraction and intraocular lens (IOL) implantation. Viscoat maintains a deep anterior chamber during anterior segment surgeries, enhances visualization during the surgical procedure, and protects the corneal endothelium and other ocular tissues. The viscoelasticity of the solution maintains the normal position of the vitreous face and prevents formation of a flat chamber during surgery. WARNINGS: Failure to follow assembly instructions or use of an alternate cannula may result in cannula detachment and potential patient injury. PRECAUTIONS: Precautions are limited to those normally associated with the surgical procedure being performed. Although sodium hyaluronate and sodium chondroitin sulfate are highly purified biological polymers, the physician should be aware of the potential allergic risks inherent in the use of any biological material. ADVERSE REACTIONS: VISCOAT® OVD has been extremely well tolerated in human and animal studies. A transient rise in intraocular pressure in the early postoperative period may be expected due to the presence of sodium hyaluronate, which has been shown to effect such a rise. It is therefore recommended that Viscoat be removed from the anterior chamber by thorough irrigation and/or aspiration at the end of surgery to minimize postoperative IOP increases. Do not overfill anterior chamber. ATTENTION: Reference the Physician Labeling/Directions for Use for a complete listing of indications, warnings and precautions. PROVISC® OVD (Sodium Hyaluronate) Ophthalmic Viscosurgical Device INDICATIONS: ProVisc® OVD is indicated for use as an ophthalmic surgical aid in the anterior segment during cataract extraction and intraocular lens (IOL) implantation. Ophthalmic viscoelastics serve to maintain a deep anterior chamber during anterior segment surgery allowing reduced trauma to the corneal endothelium and surrounding ocular tissues. They help push back the vitreous face and prevent formation of a flat chamber during surgery. PRECAUTIONS: Postoperative increases in intraocular pressure have been reported with sodium hyaluronate products. The IOP should be carefully monitored and appropriate therapy instituted if significant increases should occur. It is recommended that PROVISC® OVD be removed by irrigation and/or aspiration at the close of surgery. Do not overfill anterior chamber. Although sodium hyaluronate is a highly purified biological polymer, the physician should be aware of the potential allergic risks inherent in the use of any biological material; care should be used in patients with hypersensitivity to any components in this material. Cannula assembly instructions should be followed to prevent patient injury. ADVERSE REACTIONS: Postoperative inflammatory reactions such as hypopyon and iritis have been reported with the use of ophthalmic viscoelastics, as well as incidents of corneal edema, corneal decompensation, and a transient rise in intraocular pressure. ATTENTION: Reference the Physician Labeling/Directions for Use for a complete listing of indications, warnings and precautions. What lens characteristics are desirable in a backup IOL? I © 2011 Novartis 11/11 VIS11628JAD-PI t's unfortunately one of those things that all practitioners must bear in mind, no matter how seldom it occurs—the pos- sibility of dealing with a torn capsule. In such instances, the oft otherwise disregarded sulcus lens takes on pressing importance be- cause not just any IOL can be used, according to Mark Packer, M.D., clinical associate professor of oph- thalmology, Casey Eye Institute, Oregon Health & Science University, Portland. The fact is, there's a whole different criteria for sulcus lenses, from shape to edge design, IOL material, and more. Prime features Dr. Packer finds that for proper sul- cus placement when the capsule is in disarray, the overall diameter of the lens needs to be larger than nor- mal to work in the sulcus. "Where a 12 or 12.5 diameter may be OK in the bag, a 13 or 13.5 diameter is better in the sulcus," he said. "This means that we're dealing entirely with three-piece lenses." This is es- pecially true since many of the char- acteristics of the one-piece lenses are not compatible with sulcus place- ment. He pointed out the most com- monly used single-piece lens, the AcrySof (Alcon, Fort Worth, Texas), has a sharp anterior edge that has been associated with uveitis, glau- coma, and hyphema syndrome when placed in the sulcus. Other sulcus lens criteria are also highly specific. "We're looking at a rounded-edge, three-piece lens with a larger overall diameter; an optic size of 6 mm is OK, but a larger optic size is probably even better in the sulcus to avoid any issues with edge glare or optic capture in the pupil," Dr. Packer said. He finds that while having a rounded edge is im- portant, the lens material does not matter that much. "Either silicone or acrylic can work just fine in the sul- cus in a three-piece lens," he said. "Angulation is not critical one way or the other." He pointed out that this is mostly done to give good contact between the posterior lens surface and the capsule to help pre- vent posterior capsular opacification (PCO), which is clearly not an issue in sulcus placement. Currently Dr. Packer's go-to sulcus lens is the STAAR AQ 2010V (STAAR Surgical, Monrovia, Calif.), which he pointed out has a 13.5- mm overall length, a 6.3-mm optic, and round edges. Thomas A. Oetting, M.D., pro- fessor of clinical ophthalmology, University of Iowa, Iowa City; chief, Eye Service, and deputy director, Surgery Service, VA Medical Center, Iowa City, has a different view. "The perfect IOL for the sulcus has a large optic, long, thin haptics, a smooth anterior surface, and angulation of the haptics such that the optic is more posterior than the peripheral haptic," Dr. Oetting said. He agreed that the AQ 2010V lens is an option here. "In the classic paper on this topic by Dr. Chang and the ASCRS Clinical Committee, a silicone optic three-piece IOL is recommended for the sulcus, the STAAR AQ 2010V," Source: Dimitri Vervitsiotis/Photodisc/Getty Images Out of the bag: Sulcus lens secrets by Maxine Lipner Senior EyeWorld Contributing Editor