Attempts are made to engage vascular tissue of the limbus as posteriorly as possible but without incising the anterior conjunctival insertion to avoid conjunctival ballooning during phacoemulsification. Incision Creation and AnesthesiaĪ nonreflective crescent blade is inverted to create a freehand groove at the surgical limbus. Dispersive agents adhere better to the acrylic optic and decrease self-adherence but appear to do so to a lesser degree. Tilting or inverting the IOL allows the agent to remain in contact with the IOL surface when the IOL is removed from the container. The viscoelastic agent appears to adhere poorly to the acrylic material. The anterior optic is coated to reduce forceps adherence and to lubricate insertion. Coating the posterior surface allows contact between the cohesive viscoelastic material and the optic for at least 4 minutes before the IOL is folded and diminishes the likelihood of self-adherence. With the IOL in the manufacturer's container, the viscoelastic cannula is slid under the haptic to lift the optic and apply a thin coating of sodium hyaluronate 1% (BioLon) over the entire posterior surface of the optic.

Under sterile conditions before surgery is begun, the appropriate Sensar IOL is selected for the patient. Surgical Technique Sensar IOL Preparation A limbal hinge incision is created to decrease ingress of lidocaine into the anterior chamber during incision hydration. The intent is to decrease involuntary patient responses to pain that may hinder the surgeon's control during IOL implantation. I also describe a simple technique for hydrating the internal lateral edges of the cataract incision with preservative-free lidocaine 1% to blunt the sensation of Sensar IOL insertion. I have used these minor modifications to implant more than 700 Sensar AR40 and AR40e IOLs and have found they prevent the difficulties of self-adherence. The modifications are designed to reduce the incidence of self-adherence and improve the handling of the self-adherent lens in the anterior chamber. The folding configuration allows direct placement of the IOL in the capsular bag, minimizes damage to the IOL haptics or optic, and self-orients the haptics during unfolding. This article describes slight modifications of the familiar 3-and-9 IOL insertion technique. I prefer using insertion forceps for the intraocular control they provide during IOL implantation, particularly in patients with small pupils or excessive eye movements. The Unfolder Sapphire insertion device (Allergan, Inc.) was designed to eliminate the need to manipulate the lens with a forceps, significantly reducing the probability that the lens will adhere to itself. 9,12 Although the latter may promote capsule adherence and potentially retard PCO, it occasionally causes the lens to stick to itself or the insertion forceps in the folded position. 10,11 Second, the optic is somewhat tacky.

First, the material is soft and can be marked by insertion instruments. Two limitations are inherent to hydrophobic acrylic IOLs. 8,9 Thus far, there have been no published reports of clinically significant glistenings in Sensar acrylic IOLs, and the biconvex configuration helps eliminate anterior surface reflections. The newest Sensar, the AR40e (OptiEdge), has an edge design milled to further decrease dysphotopsias while incorporating a posterior square edge to potentially inhibit posterior capsule opacification (PCO). Peripheral dysphotopsias appear to have decreased significantly because of the optic edge design of the AR40. In 2000, Allergan Surgical was granted FDA approval for the Sensar® line of hydrophobic acrylic IOLs. Equally disturbing symptomatic complaints have arisen from the decreased contrast sensitivity associated with glistenings in the optic 6,7 and a “dull” reflective pupil resulting from the nearly plano anterior surface configuration. 1–3 The source of these dysphotopsias may be the square-edged design of the optic, 4 the high refractive index of the acrylic material, 5 or both. However, the performance of the first-generation AcrySof lenses (MA60BM and MA50BM) has been marred by iatrogenic dysphotopsias such as peripheral flashes of light and visual field defects. This lens has outstanding biocompatibility in patients at high risk for IOL-related complications and can be credited with safely advancing the availability of small-incision cataract surgery to a broader patient population. Food and Drug Administration (FDA) approval of the AcrySof® line (Alcon) in 1995. Foldable hydrophobic acrylic intraocular lenses (IOLs) have been available in the United States since the U.S.

Unfolder for the ar40e