Phakic Lens and Cataract Surgery without Viscoelastic

JOURNAL TITLE: Highlights of Ophthalmology

1. Germán R. Bianchi
Publishing Year
Author Affiliations
    1. Clínica de Ojos Dr. Nano Buenos Aires, Argentina.
  • Article keywords
    Intraocular lenses, viscoelastics, phakic, pseudophakic, cataract, surgical technique, complications, corneal endothelium, intraocular pressure, refractive surgery


    Objective: To describe a method for performing cataract surgeries and posterior chamber phakic lens procedures without viscoelastics. Background: Viscoelastics are used to obtain higher safety during intraocular maneuvers. It must be injected and then extracted. If not, ocular hypertension and toxic anterior segment syndrome can take place. However, it is possible to safely perform cataract surgeries and phakic lens procedures without viscoelastics, as the author and others have proved. Technique: For cataract surgery, two clear corneal 20-gauge (G) incisions were performed with V-lance, near the limbus (one at the 2 o\'clock mark, the other at the 10 o\'clock mark). The irrigation/aspiration (I/A) bimanual handpiece 21G cannula was introduced (it has 2 lateral vents). The micro-capsulorhexis forceps of 23G was introduced through the second incision. The irrigation bottle with a balanced salt solution (BSS) was kept high, between 80 and 100 cm, and capsulorhexis was performed, while maintaining a continuous balanced salt solution (BSS) circulation. Following that, a hydrodissection with the same I/A cannula was performed. Without removing the I/A cannula, the corneal incision was then increased, and phacoemulsification, aspiration and mass extraction were performed. The I/A cannula was placed in the 20G incision, and a foldable single piece intraocular lens was injected through the main incision. For posterior chamber phakic lens procedures, a first corneal incision at 45 degrees was performed with the 20G V-lance. The anterior chamber (AC) was maintained with a 21G I/A cannula, working in infusion/irrigation mode. A second corneal 2.8-mm incision, at 130 degrees, was performed. Meanwhile, the AC was maintained with a fluid circulation of BSS, and the phakic lens was injected. The lens was unfolded softly with the aid of the I/A cannula, and the haptics was correctly placed behind the iris, into the sulcus. Conclusion: Cataract surgeries and phakic lens procedures can be safely and efficiently performed without viscoelastics, following a specific surgical method. Clinical Relevance: To show that cataract surgeries and phakic lens procedures can be performed without viscoelastics, with some potential advantages.

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