After IOL Insertion
After removing the cataract and inserting the IOL, the surgeon removes the OVD from the anterior segment to minimize the risk of increased postoperative IOP. In an uncomplicated case with the IOL in the capsular bag, the OVD may be removed by inserting the I/A tip behind the optic or pushing the optic posteriorly to prolapse the OVD and allow its aspiration from the anterior chamber. In the setting of capsular rupture or sulcus IOL placement, removal of the OVD is performed with minimal manipulation of the IOL to avoid destabilization.
To reproduce physiologic IOP, balanced salt solution is instilled via the paracentesis incision to reform the anterior chamber. The main incision is then examined for adequate closure. If the incision leaks, both sides and/or the roof of the corneal tunnel incision can be hydrated with balanced salt solution injected via a syringe with a blunt 25- to 30-gauge irrigating tip. Hydration of the corneal incision causes temporary stromal swelling and increases the wound apposition between the roof and the floor of the tunnel. This anterior–posterior reapproximation, rather than apposition of the external corneal edges, is the critical anatomical feature that determines good wound closure.
With the continuing evolution of techniques for self-sealing incisions and the use of foldable IOLs, many surgeons elect not to suture the incision at the conclusion of a routine case. Long-term results have shown that the small incisions used in modern cataract surgery heal quickly, are relatively stable, and induce minimal astigmatism.
When there is wound leakage, however, the surgeon must be ready to use additional means of closure, such as placement of a 10-0 nylon suture that can be removed postoperatively at the slit lamp. Incisions may also be closed with corneal sealants.
Dewey S, Beiko G, Braga-Mele R, Nixon DR, Raviv T, Rosenthal K; ASCRS Cataract Clinical Committee, Instrumentation and IOLs Subcommittee. Microincisions in cataract surgery. J Cataract Refract Surg. 2014;40(9):1549–1557.
Excerpted from BCSC 2020-2021 series: Section 11 - Lens and Cataract. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.