Reverse Spin on the Alcon Toric

Review of Ophthalmology

The Alcon Toric intraocular lens is effective, as the acrylic material is “sticky” and virtually eliminates postop rotation. The downside is that it can be difficult to align with the intended axis.
The common approach is to insert the IOL and spin it just counterclockwise of the intended axis prior to full expansion of the haptics. Evacuate the viscoelastic and then nudge the IOL clockwise onto the axis marked on the cornea preoperatively. At this time the haptics will have contact with the fornices of the capsule and rotation will be difficult.
What to do when you have over-rotated the IOL? It’s a long way “around the horn” and not without risk, particularly in hyperopes with a small capsule and a lot of drag due to IOL-capsule contact.
A simple and easy way to back up the IOL (that is, spin counterclockwise) is to place the I/A tip under the superior aspect of the optic and go to irrigation, freeing the IOL optic and haptics from capsular contact. A Bechert rotator through the side port incision on the top of the IOL can spin the IOL in the reverse direction, using the I/A tip as its axis. Spin just to the right of the intended axis, and withdraw the I/A tip. Then, correct a few degrees clockwise to the planned axis.
The “reverse spin” is easier, faster and safer than rotating clockwise an additional 175 degrees with full IOL-capsule contact, and the attendant risks of zonular dehiscence or capsular rupture.