Eyeworld

JUL 2012

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

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42 EW FEATURE Casing continued from page 41 decide to put one in, make sure that you blow up the capsular bag en- tirely with adequate viscoelastic so that you get a balloon effect," Dr. Condon said. "I have put one of these rings in where I haven't ade- quately expanded and tension the bag with viscoelastic and have had the ring catch on a fold and blow right through the side of the capsular bag." Dr. Condon sees this "coat hanger" case as an eye opener. With the pseudoexfoliation patient, the whole case is about reducing zonular stress. "Right to the end, the very last removal of cortical material, you're still thinking about avoiding putting traction on the capsule and the zonules," Dr. Condon said. This means strictly controlling phaco parameters in these patients. "You want to use enough energy in the phaco process so that you're remov- ing lens rather than moving lens," he said. "You want to be absolutely removing the lens material without pushing the lens around and stress- ing the zonules that way as well." The whole time Dr. Condon is doing such cases he is thinking about every single step that reduces the stress—either the traction or the stretching of the zonules during the procedure. He treats every case as if it could go at any moment. Capsule over board Fe Fechtner E X X- P R ES Marker echtner EX-PRESS SS ® M a r er K3-8977 r r r r r arking p perime ter urate nserti on fted fo r gle for visibilit y Alcon® Watch it! Contact information Condon: 412-359-6300, garrycondon@gmail.com Harasymowycz: 514-781-0483, pavloh@igmtl.com Lewis: 916-649-1515, rlewiseyemd@yahoo.com Dr. Harasymowycz can attest that this is possible. He remembers one of his first cases involving a middle- aged French Canadian woman with pseudoexfoliation. "Back then, at least in Montreal, we didn't have capsular tension rings, Ahmed capsular tension segments, and all those types of devices. I remember that the surgery was very rock and roll and delicate because of loose zonules," Dr. Harasymowycz said. "Finally we were able to completely remove the cataract without having it fall into the vitreous." With this accomplished, Dr. Harasymowycz was quite happy and was debating whether to put the lens in the bag or not. Ultimately he decided that it was probably safer not to and pro- ceeded to the next step. "I injected Miochol [acetylcholine chloride, Bausch + Lomb, Rochester, N.Y.] to constrict the pupil and prepared to place in an anterior chamber lens, and as I injected the Miochol the entire capsule came out of the eye," he said. "So I was glad that I made that decision." He sees the case, which ended in a 20/20 result, as demonstrating how loose the zonules can be and how challenging even the lens placement can be. "We have more tools at our disposition, but placing the lens is also important," Dr. Harasymowycz said. "If you think that the zonules are absent or you think that there may be problems later for the lens to stay centered, you're probably right." Particularly with such pseudoexfoliation pa- tients, he stressed that practitioners must trust their instincts and be vigilant. EW Editors' note: Dr. Condon has financial interests with Alcon (Fort Worth, Texas) and MST. Drs. Harasymowycz and Lewis have no financial interests related to this article. February 2011 Pseudoexfoliation July 2012 ™ 97 -989 9733-989-1600ÊUÊ ÊÊ800-225 5-1195 U www.katena.com U 800-22

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