1419: How to reposition a toric IOL

It is now months after the original cataract surgery and you examine your patient and realize that the toric IOL is not at the best axis, resulting in a refractive outcome of residual astigmatism. You analyze everything carefully and plug your data into the calculator at astigmatismfix.com which tells you just how you need to reposition the toric IOL for the best refractive outcome. Now the challenge begins: you need to carefully reposition the IOL even though the capsular bag has contracted and the IOL appears to be locked in place. How to do accomplish this and then ensure that the toric IOL remains at the appropriate meridian? The secrets to success are in the video below.

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  1. Hi Uday,
    Nice video! You mentioned you inject a dispersive OVD to separate the anterior capsule from the IOL and also a dispersive OVD behind the IOL. Would a cohesive not be a better OVD to inject behind the IOL?

    1. Either option will work fine. The dispersive is more liquid and flows better around the capsular bag and behind the IOL but it is more adherent to the optic and will require more effort to remove. The cohesive is easier to remove but since it is more solid it does not flow as well around the capsule and behind the IOL.

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