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    Warm viscoelastic hastens IOL unfolding

    Technique reduces flipping during rotation; may be used for other hydrophobic acrylic implants

    Take-home message: A warm viscoelastic technique aids in the intraoperative delivery and unfolding of a hydrophobic acrylic IOL during cataract surgery.



    Lake Villa, IL—Use of warm viscoelastic is a safe, effective technique for facilitating implantation of a hydrophobic acrylic IOL (enVista MX60, Bausch + Lomb), said Mitchell A. Jackson, MD.

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    The use of warm viscoelastic enabled IOL delivery and hastened its unfolding. Inadvertent flipping of the IOL during rotation was reduced. The warm viscoelastic was very easy to remove at the end of the procedure, said Dr. Jackson, founder and chief executive officer, Jacksoneye, Lake Villa, IL.

    Surgical experience

    Dr. Jackson conducted a retrospective review of his experience with this approach in a series of 175 eyes of 99 patients who underwent phacoemulsification and implantation of the single-piece, prehydrated hydrophobic acrylic lens in a femtosecond laser-assisted cataract surgery procedure.

    Mean surgical time (including the femtosecond laser portion of the procedure) was 12 minutes, and his safety review identified no intraoperative complications, problems with IOP spikes after surgery, or evidence of increased endothelial damage.

    Based on his positive experience, Dr. Jackson said he is now using warm viscoelastic when implanting any hydrophobic acrylic IOL.

    This particular IOL “has been associated with excellent results, and its novel material has advantages for increasing resistance to damage from surgical instruments and maintaining long-term clarity,” he said.

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    However, the unique hydrophobic acrylic of the lens is relatively stiff, which causes it to open very slowly and makes it susceptible to being inadvertently flipped if rotation is attempted before unfolding is complete, he explained.

    “Warming increases flexibility of hydrophobic acrylics, and I found that using warm viscoelastic in the IOL cartridge and to fill the capsular bag greatly facilitates intraocular delivery of the [lens] and hastens its unfolding,” Dr. Jackson said. “With the switch to warm viscoelastic, [this IOL] has gone from being the slowest to the fast unfolding implant that I use.”

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