Removal times and techniques of a viscoadaptive ophthalmic viscosurgical device.
OBJECTIVE
To analyze removal techniques for Healon5 (sodium hyaluronate 2.3%).


METHODS
Center for Research on Ocular Therapeutics and Biodevices, Charleston, South Carolina, USA, and Department of Ophthalmology, Ruprecht-Karls-University, Heidelberg, Germany.


METHODS
In a standardized laboratory setup, the Miyake-Apple posterior view video technique in human autopsy eyes was used to evaluate removal of an ophthalmic viscosurgical device (OVD) from capsular bags implanted with poly(methyl methacrylate), silicone, and acrylic intraocular lenses (IOLs). Healon5 was stained with fluorescein for better visualization. Open-sky preparation and an Alcon Legacy Series 20000 phaco machine with a flow rate of 25 mL/minute and a vacuum setting of +500 mm Hg (maximum irrigation/aspiration [I/A]) were used. With Technique 1, the I/A tip was placed on the center of the IOL and maximum aspiration was applied. With Technique 2 (modified rock 'n roll technique), the I/A tip was moved in quick circular movements on top of the IOL to break the OVD chains and facilitate aspiration.


RESULTS
With Technique 1, the mean removal time was 59.0 seconds +/- 23.1 (SD) and with Technique 2, 23.6 +/- 10.3 seconds (P =.004). The removal time of Healon5 correlated with the IOL material. With Technique 2, removal was fastest with silicone IOLs (13.5 +/- 2.1 seconds) followed by PMMA IOLs (17.5 +/- 2.1 seconds). With acrylic IOLs, remnants of the OVD trapped behind the IOL optic resulted in a longer removal time of 34.1 +/- 1.2 seconds.


CONCLUSIONS
Healon5 was completely removed from the capsular bag with the modified rock 'n roll technique. With acrylic IOLs, remnants can be trapped behind the optic and may be overlooked with an unstained OVD. Aspiration behind the optic is recommended with this IOL type.
Auffarth
Gerd U
GU
Heidelberg Research Group Intraocular Lenses and Refractive Surgery, Department of Ophthalmology, Ruprecht-Karls-University of Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany. gerd_auffarth@med.uni-heidelberg.de
Holzer
Mike P
MP
Vissesook
Nithi
N
Apple
David J
DJ
Völcker
Hans E
HE
D000180:Acrylic Resins; D004322:Drainage / Q000379:methods*; D006801:Humans; D006820:Hyaluronic Acid; D019654:Lens Implantation, Intraocular; D007910:Lenses, Intraocular; D018918:Phacoemulsification; D019904:Polymethyl Methacrylate; D012826:Silicone Elastomers; D013997:Time Factors
D000180:Acrylic Resins; D012826:Silicone Elastomers; D006820:Hyaluronic Acid; D019904:Polymethyl Methacrylate