EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
Issue link: https://digital.eyeworld.org/i/115557
156 EW MEETING REPORTER March 2013 Reporting live from Hawaiian Eye 2013, Big Island, Hawaii Premium lenses in complex cases Editors' note: This Meeting Reporter contains original reporting by the EyeWorld news team from Hawaiian Eye 2013. In what he acknowledged might be a controversial stance, Dr. Lindstrom said he has been converted to the belief that diffractive multifocal IOLs can be successfully implanted in high-risk eyes, including in those patients who have had previous corneal surgery or trauma and those who have pre-existing conditions such as glaucoma, macular degeneration, corneal dystrophy, or a history of eye infection, among others. Dr. Lindstrom said he looked at the data provided by surgeries performed by his partners on patients who he previously would have considered contraindicated for premium lenses. "The outcomes were actually quite good in these patients," he said. "The group that seemed to do the worst was the glaucoma patients, but they're all in a reasonably acceptable category of 20/40 or better. Patient satisfaction also was adequate enough not to require an explant. Spectacle independence was about 75%." Dr. Lindstrom said after reviewing the data, he has moved his opinion from "absolutely no" to "maybe, with high-quality informed consent and high-quality optics." Editors' note: Dr. Lindstrom consults for the premium IOL industry. Creating support In a later talk, Dr. Steinert described in detail a scleral tunnel and glue fixation procedure for secondary IOLs, a method developed and popularized by Amar Agarwal, M.D. "This is what you do when there is no support in place and you have to create your own support," Dr. Steinert said. In other procedures, "we do see late breakage of sutured PC-IOLs, even with heavier sutures." Dr. Steinert said originally he was skeptical that the glue would create a lasting bond in scleral tunnel glue haptic fixation. "The glue is important for sealing purposes, but it's the tunnel that's responsible for the long-term stability, and it does work," he concluded. Dr. Steinert said the technique is challenging, probably as much as putting in scleral or iris sutures. "The results have the potential for better long-term stability, and, therefore, I think it is worth the effort," he said. His preferred IOL is the STAAR AQ2010V three-piece silicone IOL (STAAR Surgical, Monrovia, Calif.) because a bigger lens is easier for externalizing the haptic. "Most importantly, the haptics are made with polyimide. It is tough." "What's really remarkable is how good these eyes look in a week," Dr. Steinert said. Editors' note: Dr. Steinert has no financial interests related to his talk. Tuesday, January 22 Tuesday's Hawaiian Eye program included video-based interactive sessions on cataract and refractive surgery complications, as well as late-breaking hot topics in cataract surgery, but the main focus was on performing phacoemulsification in eyes with glaucoma. Saying "modern cataract surgery should be considered a glaucoma surgery," Kuldev Singh, M.D., Palo Alto, Calif., offered his top five reasons for performing phaco in the glaucoma patient: • Sustained IOP lowering; • No adverse effect on future trabeculectomy; • Reduced lens-related trabecular complications; • Eliminates the risk of a trabeculectomy failure in later cataract surgery; and • Improved vision. "Early cataract surgery makes sense for IOP over the long term," Dr. Singh said. For glaucoma patients receiving IOLs, Dr. Steinert recommended using capsular tension rings (CTRs) to improve centration in pseudoexfoliation glaucoma. "When in doubt, I insert the CTR. It certainly will give you that stabilization early on. If you do have