MAR 06, 2009
Cataract/Anterior Segment, Comprehensive Ophthalmology
Steve Arshinoff, MD FRCSC, creatively uses OVDs in a step-wise approach to prevent complications from intraoperative floppy-iris syndrome (IFIS) before they occur.
His approach begins with a modification of the soft shell and ultimate soft shell techniques. This, coupled with simple pharmacologic management, and use of long, tight incisions, has enabled him to manage 98 percent of Flomax cases easily - without the need for mechanical devices.
The great advantage of this technique, said Dr. Arshinoff, is that the surgeon may use it safely and effectively at any time during the procedure, unlike mechanical pupil dilators.
1. Create a tight, long incisional tunnel with an internal opening central to the pupil margin.
2. Fill the AC 60 percent with Viscoat, peripherally.
3. Complete the filling of the AC with Healon5, such that the Healon5-Viscoat boundary is at the pupillary edge.
4. Inject BSS below the Healon5 to create a fluid layer below the Healon5, over the lens capsule.
5. Make the capsulorhexis smaller than the pupil.
6. Lower the phaco aspiration rate to 20, the vacuum to less than 350, and the bottle height to 70-80 cc. Confine the surgical procedure to within the capsular bag.
In this full text document, Dr. Arshinoff discusses his technique in greater detail.