Fig. 25.2 Condensation on the IOL in the area of the posterior capsulectomy. (a) The already-poor image of the retina in the air-filled eye is further deteriorated by fluid condensation in the area of the posterior capsulectomy. (b) A tiny film of dispersive viscoelastic is spread over the IOL back surface. The use of too much or cohesive type of visco must be avoided as it would also cause distortion of the view (making the visco film too thick or uneven)

25.2.5 The Posterior Capsule

It is advisable to always do a capsulectomy in the pseudophakic eye to avoid intraoperative interference (for the surgeon) and postoperative interference (for the patient, see Sect. 4.5). Rarely, however, such a capsulectomy may bring undesirable consequences.

•Fogging during F-A-X, see above.

•If silicone oil needs to be implanted and the eye has a silicone IOL implant,37 the oil will stick to the lens.

–I use a forceps wrapped in cotton (see Fig. 25.1) and push the oil away from the center, toward the edge of the IOL where it is less visible; removal of the oil is virtually impossible.

25.2.6 The Vitreous Cavity

Dealing with materials such as blood and pus are obvious indications for PPV and are discussed in various chapters in Part V. The only issue mentioned here is Schlieren: draining thick (old) subretinal fluid internally temporarily interferes with visualization until the viscous fluid is cleared from the vitreous cavity.

Pearl

The subretinal fluid can be so viscous that passive aspiration with the fluid needle is ineffective. Active aspiration is needed, preferably with the probe because even the cutting may have to be activated (see Sect. 31.1.2).

37 Shockingly, some cataract surgeons still use silicone IOLs because they are less expensive.