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.

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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.