Sir,

We have read the article by Khokhar S et al1 with a great interest. The authors have rightly compared two techniques in terms of wound enlargement, wound integrity, and incidence of Descemet’s membrane detachment. The authors state that manual injection of IOL with the compatible injector–cartridge system causes more enlargement on the final wound size and less posterior wound integrity when compared with motorized injector system.

We just wanted to share our practical approach during the manual foldable IOL injection. In our approach, even though we use compatible injector–cartridge system with microincision, we prefer to take help of wound assistance to keep wound size, integrity, and posterior Descemet’s membrane during foldable IOL injection. However, the injection of IOL by wound assistance requires excess use of OVD to provide adequate globe tonus. To minimize the amount of OVD used, irrigation solution is supposed to be used for adequate globe tonus. On the basis of this reasoning, we use hydro-visco-implantation technique,2 which is a modified technique of both classic and hydroimplantation techniques3 for IOL injection by the wound assistance during microincisional cataract surgery. We generally place the tip of the cartridge into the wound edges without entering the anterior chamber.

In this technique, the capsular bag is filled approximately up to half with OVD and the anterior chamber is formed by bimanual irrigation cannula with continuous irrigation mode from the side port. After providing adequate tonus, the continuous mode could be put off to reduce the wash effect on OVD during the injection of IOL. After the injection of foldable IOL with the support of wound edges is completed, firm downward pressure could be applied with the tip of the aspiration cannula to the posterior lip of main incision and dynamic outflow could be created, and then the viscoelastic material could be removed from the eye without the necessity of using aspiration cannula.

As a result, during the procedure the injector does not exceed the cornea in full thickness, and it may provide not to enlarge the incision size, better wound integrity, and protection of the posterior Descemet’s membrane integrity.