15 EyeWorld Asia-Pacific | September 2024 EDITOR’S PICKS Selected cataract surgical tips presented at the Wisdom of the Kung Fu Masters symposium the superotemporal/inferonasal axis in the right eye and the superonasal/inferotemporal axis in the left eye. The toric IOL generally needs to be rotated to the designed axis clockwise and refined into the final position after removing the viscoelastic in the anterior chamber, especially beneath the IOL, to prevent postoperative IOL rotation from the planned axis. In some cases, especially after the viscoelastic is removed from beneath the IOL, the position of the IOL may be over the planned axis. The surgeon generally needs to rotate the IOL clockwise almost 180 degrees to the preoperative design position. Rotating the IOL in the bag without viscoelastic, using either a one-hand or twohands technique, while employing a second instrument, can exert force on the zonules and possibly cause zonular injury, affecting the IOL’s position intraoperatively and postoperatively. Zonular damage can create decentration, tilt, and/or anterior/posterior movement of the IOL, which directly affects the effective lens position (ELP) postoperatively and causes undesired residual refractive error that impacts patient vision. DUCK is a technique to rotate the IOL counterclockwise with minimal force applied to the zonule, consisting of three simple steps: Step 1: With the I/A handpiece, go underneath the toric IOL with irrigation in an upward/downward or oblique position. Step 2: Gently tilt the IOL in the capsular bag and remove all viscoelastic from underneath the IOL. Step 3: Use the tip of the I/A handpiece to rotate the IOL counterclockwise (with continuous irrigation) at the peripheral one-third of the IOL optic to the designed axis. DUCK Step 1, with irrigation directed upward/downward, allows the surgeon to stretch the capsular bag, push the IOL up to create a slight tilt, and push the posterior capsule backward, creating space for counterclockwise rotation. Step 2 ensures that all viscoelastic underneath the IOL is completely removed, and Step 3 safely and gently performs the counterclockwise rotation with adequate space between the IOL and posterior capsule, created by the irrigation of the I/A handpiece. Step 3 must be performed gently without creating too much tilt of the IOL, safely creating the rotation force counterclockwise by lifting the IOL at the peripheral one-third of the optic and gently moving sideways from right to left. This step can be done repetitively using either a one-hand technique with the I/A handpiece only (the author’s preference) or bimanually, together with a second instrument via a clear corneal incision. Thus, DUCK should be performed when the IOL is misplaced beyond the design axis by less than 30 to 45 degrees; otherwise, standard clockwise rotation is recommended. In summary, DUCK is a novel, safe, easy, and effective surgical technique for performing counterclockwise IOL rotation in the bag, used to refine the final intraoperative position of a 1-piece C-loop toric IOL.
RkJQdWJsaXNoZXIy Njk2NTg0