Assessment of adequate removal of ophthalmic viscoelastic device with irrigation/aspiration by quantifying intraocular lens 'Judders'.

Background: To assess the efficacy of 'Judders' as a technique reflecting adequacy of removal of ophthalmic viscoelastic device in cataract surgery.

Design: Prospective, consecutive, single surgeon study.

Participants: Cohort of 223 patients undergoing phacoemulsification.

Methods: 'Judders' are periodic, abrupt, horizontal displacements of the intraocular lens causing balanced salt solution to displace retropseudophakic ophthalmic viscoelastic device. The number of 'Judders' was correlated with axial length, anterior chamber depth, and preoperative and postoperative intraocular pressure.

Main Outcome Measures: Number of 'Judders', axial length, anterior chamber depth, day 1 postoperative intraocular pressure.

Results: The mean number of 'Judders' was 3.2. There was a positive association between the number of 'Judders' and axial length, but not between number of 'Judders' and anterior chamber depth. Mean preoperative intraocular pressure was 14.5 mmHg; mean day 1 postoperative intraocular pressure was 15.6 mmHg. Intraocular pressure rose in 47% of cases. In six cases (5%), intraocular pressure rose greater than 10 mmHg (range 11-23 mmHg) from the preoperative level.

Conclusions: Aspirating ophthalmic viscoelastic device with the irrigation/aspiration tip posterior to the intraocular lens may be associated with the risk of a posterior capsule tear. Maintaining the irrigation/aspiration tip anterior to the intraocular lens may offer a significant safety advantage. The number of 'Judders', usually 3-4, appears to be a safe and reliable end-point of complete ophthalmic viscoelastic device removal. There were significantly more 'Judders' in eyes with a longer axial length. The safety and efficacy of 'Judders' are reflected by the stable mean postoperative intraocular pressure.