Eyeworld

MAR 2013

EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.

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How can you hit a moving target? March 2013 Simplifying continued from page 20 Eyes move. Eyes rotate. Pupils shift. Advanced Control Eye Tracker (ACE) for the TECHNOLAS 217z100 Excimer Laser Platform is the most comprehensive eye tracker available in the US. Complete compensation of rotational errors, both static and dynamic, from diagnostics to the very end of the ablation. Instantaneous adjustment of the ablation pro3le as the eye rotates. Increased precision through iris recognition for all treatments – wavefront-guided, cylinder, or sphere only. Peace of mind for you and your patients. ACE has you covered. Some of the products and/or specifc features as well as the procedures featured in this document may not be approved in your country and thus may not be available there. Design and speci.cations are subject to change without prior notice as a result of ongoing technical development. Please contact our regional representative regarding individual availability in your respective market. The trademarks (™ and ®) and logos used in this document are the property of Technolas Perfect Vision GmbH or the respective owner. kbcomunicacion. Ref. TPV-001/01-2013 © 2013 Technolas Perfect Vision GmbH. All rights reserved. Technolas Perfect Vision Inc 3365 Tree Court Industrial Blvd. St. Louis, MO, 63566 USA Customer Service 1-888 704 3601- Domestic Customer Service 636-226 3600 - International Technolas Perfect Vision GmbH Messerschmittstr. 5 + 7 84996 Munich, Germany www.TechnolasPV.com A 3 mm vertically oriented temporal conjunctival and Tenon's capsule dissection 2 mm posterior to the limbus creates space for a 3 mm, 1/3 thickness, scleral groove 2.5 mm posterior to the limbus. A 9-0 polypropylene double-armed suture on a long, curved needle (P99062, Visionary Medical Supplies, Madison, Wis.) is passed through the margin of the partial thickness scleral groove opposite the stab incision, up through the optic-haptic portion of the IOL-capsular bag complex, and out the peripheral cornea (Figure 2). When the needle does not easily pass through the IOL-bag complex, countertraction with intraocular microforceps assists successful passage of the needle. A single 1 mm full thickness stab incision is then made through the sclera at the end of the partial thickness groove opposite the site of suture passage. Next, a 25-gauge suture snare (MST, Redmond, Wash.) is passed through the full thickness scleral incision to retrieve the polypropylene suture anterior to the PCIOL-bag complex (Figure 3). After retrieving the suture, the needle is cut and the suture tied at the site of the scleral groove. A slip knot allows subsequent IOL centration. The same process is then repeated at the nasal aspect to secure the fellow optic-haptic portion of the IOL-bag complex (Figure 4). However, the nasal polypropylene suture needle pass and 1 mm stab incision for suture retrieval should counter the temporal sites to prevent IOL tilt. The suture tension on both haptics can then be adjusted to center the IOL before the knots are secured and then the knots buried. The conjunctiva is closed with a single buried 8-0 vicryl suture (Figure 5). If there is vitreous involvement, a limited pars plana vitrectomy may be required either early or at the conclusion of fixation. traocular capsular bag stripping. As has been noted in a paper by Chan et al, which utilized a similar fixation technique, oblique suture orientation prevents significant IOL tilt.4 Our technique for ab externo scleral fixation can also be achieved with an angled iris hook, but suture retrieval with the snare instrument makes the maneuver easier and minimizes uveal trauma. While our modifications may speed the fixation process, late inthe-bag IOL dislocation surgery necessitates additional time in clinical assessment, preop planning, and intraoperative repair. Many patients with late in-the-bag IOL dislocation have significant ocular comorbidities, and consideration of concomitant ocular disease, particularly pseudoexfoliation glaucoma, is critical to successful patient outcomes. Ab externo suture loop retrieval and scleral fixation is known to safely reposition late in-the-bag IOL dislocation, and suture retrieval with the snare instrument through a small scleral stab incision may ease this challenging surgery and provide the most atraumatic means of repair. EW Summary and conclusion Shouldn't your LASIK treatment keep up? Editors' note: Dr. Kirk practices at Kirk Eye Center in River Forest, Ill. Dr. Kirk has no financial interests related to this article. Dr. Condon is chairman of ophthalmology, Allegheny General Hospital, and associate professor of ophthalmology, Drexel University College of Medicine, Pittsburgh. Dr. Condon has financial interests with Alcon and MST. Since the introduction of the AcrySof single-piece acrylic IOL (Alcon) in 2000, the single-piece acrylic IOL has maintained its place as the most commonly implanted in-the-bag IOL in the U.S. When these single-piece acrylic IOLs undergo late dislocation, they may not be amenable to iris fixation as this technique may cause chronic iris chafing.3 Our technique minimizes complicated intraocular manipulations and eliminates the need for in- References 1. Kirk TQ, Condon GP. Simplified ab-externo scleral fixation of late in-the-bag IOL dislocation. J Cataract Refract Surg 2012; 38:17111715. 2. Monestam, EI. Incidence of Dislocation of Intraocular Lenses and Pseudophakodonesis 10 years after Cataract Surgery. Ophthalmology 2009; 116: 2315-20. 3. Dorey MW, Condon GP. Management of dislocated lenses. In Beardsley TL, Colvard M. AAO Focal Points Clinical Modules for Ophthalmologists. Sept 2009; 9-10. 4. Chan CA, Crandall AS, Ahmed IK. Ab-externo scleral suture loop fixation for posterior chamber intraocular lens decentration. J Cataract Refract Surg 2006; 32:121-128. Contact information Condon: garrycondon@gmail.com Kirk: tylerqkirk@gmail.com

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