NOV 2012

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

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November 2012 to provide support Capsule Polishers Figure 3. Nucleus pieces removed. Now one can glue the haptics to the sclera after assessing the centration of the IOL Source (all): Amar Agarwal, F.R.C.S. with a retinal detachment post-op. The three-piece foldable IOL is loaded onto the injector and the cartridge passed into the anterior chamber (AC). The haptic tip should be slightly out of the cartridge so that when one goes to grasp the haptic with the glued IOL forceps, it is easy. The haptic tip is grasped with the glued IOL forceps and while the IOL is unfolded, the haptic tip is still caught. There are no chances of the IOL falling down, as the haptic is caught with the forceps and the trailing haptic is still outside the clear corneal incision. The haptic is subsequently externalized. Using the handshake technique, the trailing haptic is externalized. If the nuclear pieces are occupying a lot of space in the AC, this maneuver is sometimes difficult. One should use viscoelastic to dislodge the pieces to the side to gain visualization. A 26-g needle is used to create the Scharioth pocket, and the haptic is tucked into the intrascleral pocket. Phacoemulsification of the nu- clear pieces is performed (Figures 2 and 3). An artificial posterior capsule has been created using the combina- tion of the glued IOL and the IOL scaffold technique. This prevents the nuclear fragments from falling into the vitreous cavity. Finally, air is in- jected into the AC and fibrin glue is used to seal the haptics in the sclera. Problems The biggest problem is if the nuclear pieces are too big, visualization of the haptic is difficult. Another issue is to be careful of endothelial dam- age. One should use viscoelastics to prevent endothelial damage. Conclusion By combining the glued IOL and the IOL scaffold techniques, one can create an artificial posterior capsule in certain select cases of capsular deficiency where the iris is deficient or the pupil is too large to support an IOL. EW References 1. Agarwal A, Kumar DA, Jacob S, et al. Fibrin glue-assisted sutureless posterior chamber intraocular lens implantation in eyes with deficient posterior capsules. J Cataract Refract Surg. 2008;34:1433-1438. 2. Kumar DA, Agarwal A, et al. IOL scaffold technique for posterior capsular rupture. J Refract Surg. 2012 May;28(5):314-5. 3. Agarwal A, Jacob S, Kumar DA, et al. Glued IOL scaffolding to create an artificial posterior capsule for nucleus removal in eyes with pos- terior capsular rent and insufficient iris and sulcus support: a new technique. Article in press. J Cataract Refract Surg. Contact information Agarwal: + 91 44 2811 6233, dragarwal@vsnl.com 1322 Rev.A Call 727-209-2244 For More Information. 3360 Scherer Drive, Suite B, St. Petersburg, FL 33716 s4EL s&AX %MAIL )NFO 2HEIN-EDICAL COMs7EBSITE WWW 2HEIN-EDICAL COM $EVELOPED)N#OORDINATION7ITH*OHN2 3HEPHERD - $ $EVELOPED)N#OORDINATION7ITH-ICHAEL- (ENRY- $ 2APHAEL &RESCOOF!DAMAND%VE BBBB 8-13215-D: Shepherd* Anterior/Posterior Capsule Polisher-Double Ended 8-13214: Shepherd* Anterior/Posterior Capsule Polisher-Right 8-13215: Shepherd* Anterior/Posterior Capsule Polisher-Left 8-13229: Henry** Anterior/Posterior Capsule Polisher

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