When we fill the eye with viscoelastic, we push it with the greatest force into the opposite angle of the eye. This area, 180 degrees away from the paracentesis incision, is where the viscoelastic tends to stick the most. It can even remain in the eye after a seemingly thorough washout of the anterior segment using the irrigation / aspiration (I/A) probe on high flow and high vacuum settings. The retained viscoelastic will cause increased intra-ocular pressure in the post-op period and will likely slow the visual recovery.
The technique to ensure that all viscoelastic has been removed, I use balanced salt solution (BSS) on a 27ga blunt cannula to wash out and sweep the opposite angle. This frees up any retained viscoelastic for easy removal. It also means that 99% of the time, there is no retained viscoelastic and the intra-ocular pressure is normal on post-op day 1. That makes for a happy patient and a happy surgeon.
Click below to learn this important technique for cataract surgery:
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