Surgical pearls

I have made two changes in my surgical technique to enhance outcomes with presbyopia-correcting IOLs.

1) I use a slightly smaller capsulorhexis than I do for monofocal IOLs (4.5 mm). This seems to allow for better centration and ensures that the implant will be completely in the bag with no tilting or induced optical aberrations.

2) In addition to polishing the posterior capsule, I vacuum the posterior surface of the anterior capsule. This removes epithelial cells, which are sometimes invisible through the microscope, and other debris, reducing inflammation and speeding patients' visual recovery.