Amar Agarwal - [email protected] Soosan Jacob - [email protected] Update 17

contacts cornea

IOL SCAFFOLD Novel technique enables successful PCR management while maintaining a small incision by Cheryl Guttman Krader in Vienna

he IOL scaffold is a useful new it is the only one in which the scaffold is technique for preventing further the IOL itself and so allows the same IOL complications and achieving a to be implanted into the sulcus after lens successful visual outcome after removal.” Tposterior capsular rupture (PCR), said Amar The IOL scaffold technique can be used Agarwal MD, at the XXIX Congress of after the nucleus pieces have been brought the ESCRS. into the anterior chamber, but it should be The procedure is intended for use in cases limited to the management of PCR in eyes where PCR occurs with a non-emulsified, with soft to moderate nuclei, considering the moderate to soft nucleus. It uses a three- risk of corneal damage if the is very piece foldable IOL as a scaffold or barrier hard, Prof Agarwal said. to compartmentalise the anterior and In performing the technique, the first step posterior chambers, thereby preventing is to adjust the infusion or fix an anterior vitreous prolapse, vitreous hydration, and chamber maintainer to prevent anterior nucleus drop. Because the IOL is inserted chamber collapse. Then any vitreous that through the existing corneal incision, the has prolapsed into the anterior chamber is IOL scaffold technique with 23 G trocar infusion and Three-piece foldable IOL injected through the clear corneal IOL scaffold technique has advantages for removed by anterior vitrectomy. moderately soft nucleus. Posterior capsular rupture during wound maintaining anterior chamber stability and Next, the nuclear fragments are nucleus removal IOP while also preserving the astigmatic manoeuvred to lie above the iris in the benefit of sutureless, small incision surgery, anterior chamber. The IOL is introduced said Prof Agarwal, chairman and managing via the existing corneal incision and director, Dr Agarwal’s Group of Eye positioned beneath the nucleus with the Hospitals, , . leading haptic above the iris and the trailing “The word scaffold comes from the haptic remaining just outside the incision. A medieval Latin word scaffaldus that means dispersive viscoelastic is used to coat temporary platform. In the IOL scaffold the cornea. technique, the three-piece IOL is acting as “Using a dialler in the non-dominant a temporary platform or artificial posterior hand, the surgeon should manoeuvre the capsule, preventing nuclear fragments from optic-haptic junction on the trailing haptic falling into the vitreous cavity,” he explained. side so that the IOL blocks the pupil. “There are several other methods that Keeping the trailing haptic outside the surgeons can use to prevent nucleus drop incision also enables adjustment of the IOL after PCR, including the phaco sandwich, position if the nucleus rotates while reducing posterior assisted levitation using a Sheet’s the risk of IOL drop,” noted Prof Agarwal. glide, or Keiki Mehta's HEMA life boat. Once the IOL scaffold is established, the Nucleus removed with phaco probe Nucleus completely emulsified However, the IOL scaffold is unique in that surgeon can proceed to remove the nuclear above the IOL optic fragments using the phaco probe with low flow and vacuum settings. Any residual cortex is then removed using the vitrectomy probe in suction mode with low aspiration. There are several The IOL is then manoeuvred over the capsular remnants in the ciliary sulcus. “other methods that If capsular support is inadequate, a glued surgeons can use to IOL procedure is performed. The infusion prevent nucleus drop cannula/anterior chamber maintainer is after PCR, including removed, and the wound hydrated. the phaco sandwich, Postoperative treatment includes posterior assisted fluoroquinolone and corticosteroid drops levitation using a four times daily for two weeks with a short- acting mydriatic drop twice daily for Sheet’s glide, or three days. Keiki Mehta’s HEMA life boat. Dr Soosan Jacob, senior consultant, Dr Courtesy of Amar Agarwal MD Agarwal's Group of Eye Hospitals, was IOL pushed into the ciliary sulcus IOL well centred at the end of surgery Amar Agarwal MD also involved in carrying out the research mentioned in this article.

EUROTIMES | Volume 17 | Issue 2