EyeWorld Asia-Pacific September 2015 Issue

September 2015 15 EWAP FEATURE the microscope, they have a mark that the laser has made on the cornea that makes it very easy for me to see how I’m going to orient the lens,” he added. Jonathan Rubenstein, MD , vice chairman and Deutsch family professor of ophthalmology, Rush University Medical Center, Chicago, uses a slightly different technique. “Preoperatively, I mark the 6 o’clock position on the limbus with a very fine tip surgical marker with the patient looking at my nose with both eyes open,” he said. “Then in the operating room, I align the 6 o’clock mark with the 90-degree axis mark on a Dell astigmatic marker. I twist the internal bezel of the Dell marker to be aligned with the patient’s steep axis of astigmatism, therefore making the two marks on the limbus at the steep axis of astigmatism.” Dial the lens (almost) into position and remove the viscoelastic To prevent postop rotation of the lens, make sure that all viscoelastic and cortical material are removed before dialing the lens into its final position. “If you have problems with the subincisional cortex, you might give some thought to using bimanual [irrigation and aspiration, I/A] to remove it,” Dr. Hamilton said. “You want even contraction of the capsule over the lens.” After phacoemulsification, align the lens with the axis or leave it slightly counterclockwise to the axis, remove the viscoelastic, and then tap it into the final position. Although these are the basic steps, most surgeons have their own preferred method for executing this procedure. Dr. Kontos prefers to leave the lens slightly counterclockwise to the intended axis before removing the viscoelastic. “I’ll place the lens in the bag and spin it into position, pretty close to the position it needs to be in,” he said. “I’ll go in under the lens with a cannula and squirt balanced salt solution back there to make sure there’s no viscoelastic behind the lens, and then I rotate the lens into its final position with a Sinskey hook.” “I leave the lens about 10 degrees on the counterclockwise side of the mark,” Dr. Hamilton said. “I remove the viscoelastic and use the I/A handpiece to block the clockwise rotation that tends to occur as you remove viscoelastic from the bag. Then I use the I/A handpiece with irrigation going to finalize the position, and I do a little tap on the center of the lens to push it against the posterior capsule.” “I place my toric IOL on axis and then gently keep the IOL from rotating with my soft-tipped I/A handpiece while removing the viscoelastic,” Dr. Rubenstein said. “I slide the IOL back and forth, on axis, until all of the viscoelastic shakes out from behind the IOL. You see a flutter when the cohesive OVD is removed, but by holding the IOL with the I/A tip, the IOL does not rotate.” After all of the viscoelastic is removed, the lens should be aligned with the axis and positioned securely against the posterior capsule to prevent postop rotation. “I check the final alignment continued on page 16 IMAGING SOLUTIONS From the leader in slit lamp imaging Outstanding image quality Equipped with an ultra-sensitive camera the new IM 900 produces images of exceptional quality even under difficult light conditions. Simple image capturing Fast and accurate automatic exposure control allows sim- ple image capturing while you are concentrating on the patient. Perfect network integration EyeSuite makes your slit lamp networkable both with other Haag-Streit devices and your practice network. www.haag-streit.com