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Up Front | Nov/Dec 2016

Look Ma, No Viscoelastic!

As financial challenges mount inexorably, surgeons find ways to control costs and save OR time. Viscoelastics compose a large percentage of case costs and require additional time for removal.

To limit costs, the selected dispersive viscoelastic for phacoemulsification is often used during the lens’ insertion. Avoidance of a second cohesive viscoelastic does reduce expense, but it incurs a time penalty, because the dispersive agent is more difficult to remove. Furthermore, the additional irrigation, with its attendant endothelial shear and required maneuvers, is another consideration.


Lance S. Ferguson, MD, demonstrates lens insertion without viscoelastic.


Rather than inject a second aliquot of viscoelastic to inflate the bag, I recommend simply placing a Lewicki cannula through the existing paracentesis incision. An experienced technician can connect this cannula to the infusion line in a few seconds, and I find that the chamber remains remarkably stable for insertion of the IOL. Reconnecting the I/A handpiece to the infusion line is likewise a fast maneuver, allowing one brief final washout of the anterior chamber and refinement of the IOL’s position.

Lance S. Ferguson, MD
Lance S. Ferguson, MD
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