EyeWorld India March 2013 Issue

54 March 2013 EW NEWS & OPINION experience with Viscoat,” he said. He finds that Viscoat tends to be ropey and disrupts the red reflex, while EndoCoat tends to be much more uniform. Two aces in the hole Meanwhile, because Preston H. Blomquist, MD , professor, Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas, Texas, USA, always uses dispersive and cohesive viscoelastics in tandem, he favors DuoVisc (Alcon). “I am a great believer in Steve Arshinoff’s soft shell technique,” he said. With this, the cohesive viscoelastic opens up the space in the anterior chamber while the dispersive agent helps to protect the endothelium during phacoemulsification. Accordingly, he pointed out with the DuoVisc he gets the dispersive Viscoat as well as the cohesive ProVisc. “The DuoVisc is nice because you have the two separate viscoelastics that you can put where you want and have them function as you want them to,” he said. For a complex case of zonular dehiscence, he finds this helps to simplify the situation. “I want to use my dispersive viscoelastic to tamponade the vitreous so that it has no way to come around the edge of the lens in the area where you have zonular dehiscence,” he said. “Then I put my cohesive viscoelastic on top of that to open up the space to perform the surgery.” Together these each work to their best advantage, Dr. Blomquist finds. The viscoadaptive bridge A final category of OVDs that can prove helpful in complex cases is viscoadaptive agents, such as Healon5 (AMO), which has characteristics of cohesives and is also pseudodispersive under high flow conditions. “Healon5 is called viscoadaptive because under some conditions it can actually changes its rheologic behavior,” Dr. Arshinoff said. “Under high flow conditions it behaves as a solid, so it starts to fracture apart.” This makes it a pseudodispersive. Likewise, when stationary, Healon5 is exceedingly viscous, like a cohesive, good for maintaining anterior chamber depth. One of the strengths of viscoadaptives, Dr. Arshinoff stressed, is this viscosity. “They are so viscous they don’t allow water to leak through them,” he said. “So you can use balanced salt as a second OVD because the viscoadaptive isolates it and does not mix with it.” The viscoadaptive OVD can be used to block the incision, with a solution of lidocaine and phenylephrine serving in place of balanced salt in the style of the “ultimate soft shell.” This solution causes excellent dilation of the pupil and makes the procedure easier. When in need of a viscoadaptive, Dr. Arshinoff favors Healon5, which he terms the prototype. Overall, Dr. Arshinoff encourages practitioners to look at each case as if it were involving physically separable spaces rather than a single surgical space, keeping in mind the different OVD properties. If a practitioner keeps three or four OVDs on hand, this can make it easier to deal with complex cases. “Almost all of them end up being quite simple because you have rigged the game for yourself like a card player who rigs the cards before he plays,” he said. “If you rig the game before you start, things that appeared very difficult really aren’t hard at all.” EWAP Editors’ note: Dr. Arshinoff has financial interests with Alcon, AMO, and Bausch + Lomb and has consulted for all of the OVD companies. Dr. Blomquist has no financial interests related to this article. Dr. Henderson has financial interests with Alcon and Bausch + Lomb. Dr. Steinert has financial interests with AMO. Contact information Arshinoff: 416-745-6969, ifix2is@sympatico.ca Blomquist: 214-648-3770, preston. blomquist@utsouthwestern.edu Henderson: 617-723-2015, bahenderson@eyeboston.com Steinert: 949-824-0327, steinert@uci.edu Experts - from page 53 DATE MEETING VENUE April 19-23 ASCRS-ASOA Symposium & Congress (ASCRS-ASOA) www.ascrs.org San Francisco, USA June 27-29 28th Annual Meeting of the Japanese Society of Cataract & Refractive Surgery (JSCRS) http://www.congre.co.jp/jscrs2013/english/contents/greeting.html Tokyo, Japan July 3-6 2013 AUSCRS www.auscrsthemeetingplace.com.au Uluru, Australia July 6-8 2013 Indian Intraocular Implant & Refractive Surgery Convention (IIRSI) www.iirsi.com Chennai, India July 11-14 26th APACRS Annual Meeting – A Global Focus on the Anterior Segment www.apacrs.org Singapore July 14-16 An Intercontinental Perspective of Pediatric Ophthalmology & Strabismus Singapore National Eye Centre (SNEC) and AAPOS Joint Meeting http://www.aapos.org Singapore October 5-9 XXXI Congress of the ESCRS www.escrs.org Amsterdam, Netherlands November 16-19 Annual Meeting of American Academy of Ophthalmology (AAO) www.aao.org Chicago, USA CALENDAR OF MEETINGS 2013