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    Reverse optic capture effective for posterior capsule tears

    Eugene, OR–All surgeons, no matter how experienced, encounter tough cases that require creative approaches.

    Richard Hoffman, MD, described such a patient with a 2+ nuclear sclerotic cataract that he removed using a standard bimanual technique, which progressed routinely.

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    Dr. Hoffman used a horizontal chopping technique to remove the nucleus and filled the capsular bag with a cohesive viscoelastic (OVD). The anterior capsulorhexis and posterior capsule were intact.

    Dr. Hoffman, clinical associate professor of ophthalmology, Oregon Health & Science University, Eugene, OR, injected a single-piece hydrophobic acrylic IOL into the bag. The haptics were covered with polymethylmethacrylate mittens to prevent them form sticking to the optic. 

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    During the centering of the IOL, a crease in the posterior capsule was visible. Dr. Hoffman hypothesized that it was a zonular dialysis with a wrinkled bag that might resolve with gentle pushing down on the IOL. Repeated pushing did not reach the desired end.

    Since the lens was centered, Dr. Hoffman started to remove the OVD. In doing so, the IOL began to shimmy and vitreous was visible in the aspirating cannula. The IOL appeared slightly tilted and moved down toward what Dr. Hoffman described as an obvious opening in the equator of the bag.

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    • [email protected]
      I also use the Hoya iSert IOL used in this video. I have had 2 suspected cases of equatorial PC tears both of which did well with IOL rotation away from the suspected tear. No vitreous presentation occurred. The IOLs have stayed stable. This is an excellent technique for securely fixating the IOL. My recommendation when using this IOL is to pull back a little once the optic has cleared the injector so as not to push the IOL too far towards the equator. With the exception of this particular problem, I find this IOL one of the easiest to insert, haptics never stick, excellent optics, and so far a very low PCO rate.

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