Surgeons in training often ask, “Do I need to remove the viscoelastic from behind the IOL at the end of the case?” And the answer is not as simple as it seems. While I do this maneuver in nearly 100% of my cataract surgeries, it is not easy for a less experienced surgeon to do so.
We have to weigh the risks versus the benefits of going behind the IOL versus simply rocking the optic back and forth to remove the viscoelastic. If you have performed less than 50 cataract surgeries and you are early in the learning curve, then it may be too much of a risk for damaging the capsular bag when the IA probe tip is placed behind the optic. Retained viscoelastic can induce a post-operative pressure spike as the thick material attempts to go through the trabecular meshwork. It can also cause unintended refractive effects if the capsular bag stays distended or if the viscoelastic allows the optic to shift or move. For a toric IOL or a diffractive multifocal IOL, where optic centration and rotational positioning are critical to the refractive success, removing the viscoelastic is a must.
Click below to learn how to safely perform this maneuver in cataract surgery:
Very nice video👌……True someone should always do it, but making rhexis sometimes smaller than 5mm , we need to be careful to avoid zonular dialysis ( though it may be very suttle) Also after removal of large bulky cataract PC tend to be loose & shaggy which might be caught if we do aspiration below the IOL….. 👍
Very good points. Another reason to avoid the baby rhexis