Dr. Carlson's pre-operative "timeout" procedure

At the innovative Video Journal Club Meeting last night graciously held at the estate of Drs. Terry and Ellie Kim, we discussed several surgical techniques including those that enable the safe and effective removal / exchange of an intraocular lens (IOL) after prior cataract surgery.  Patients receiving the ReStor Multifocal IOL on occasion experience severe and persistent glare and halos and may benefit from removal and exchange for a high quality monofocal IOL.  This should only be entertained after fully addressing the patient’s tear film, ocular surface, posterior capsule, posterior segment, residual refractive error and the patient’s “expectational” and emotional status.  Important preoperative considerations include: proper IOL power, position, status of the posterior capsule and anterior hyaloid face, duration of healing from previous surgery, capsular adhesions, zonular integrity, and the surgeons experience and comfort with handling similar cases.  We reviewed one case that proved particularly challenging to the surgeon – which would have been much easier if a more cohesive viscoelastic (better for manipulating tissue required for capsular bag re-opening) rather than a dispersivie viscoelastic (better when OVD retention is a priority).  Additionally, it is important to completely open and free up the terminal portion of the loop that has “cocooned” into a scarred capsular fornix.  Respecting this aspect of the procedure preserves zonular integrity and also allows placing the new IOL within the capsular bag rather than the sulcus.  Here is a separate case recently performed by Alan N. Carlson, M.D., Professor of Ophthalmology, Chief of the Corneal and Refractive Surgery Service at the Duke Eye Center in Durham, NC that carefully demonstrates these suggested points for the safe and effective removal and exchange of a ReStor IOL for a high quality monofocal implant.