CHAPTER 14 Irrigation and aspiration

Removal of viscoelastic with I and A following implantation of the IOL is considered, in the modular teaching method, to represent the least risky step in cataract surgery1. For experienced surgeons even cortical I and A may therefore be taken for granted. However, there are still some valuable lessons to be learned from considering the techniques and technology employed.

Irrigation of balanced salt solution into the eye while cortical material or viscoelastic is simultaneously aspirated with suction is known simply as ‘I and A’ or ‘I/A’ by cataract surgeons. The Simcoe dual bore cannula is the prototype instrument for this procedure: irrigation fluid runs into the eye by gravity, and suction is created by manually pulling back on the plunger of a syringe. Mechanical I/A, in which the phaco machine provides the suction by either a peristaltic or venturi pump, has become standard procedure wherever phaco machines are used.

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