Eyeworld

JUL 2012

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

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July 2012 EW MEETING REPORTER 59 Ehud I. Assia, M.D., Israel failed PKs or DSAEKs, glaucoma, complicated cataract surgery with AC IOLs, or aphakia," he said. "These were the more high-risk cases." At 3 months, EC loss was 10.2% and increased significantly at 12 months with 29.1%. There were three donor dislocations, one pri- mary graft failure, and one IOL dislocation. "This told us that the EndoGlide could minimize cell loss in this group, which is important because this is a high-risk group with increasing cell loss with time," he said. The second version of the EndoGlide under development is the EndoGlide UltraThin, which was created "because of the increased trend toward very thin donors," Dr. Tan explained. Finally, Dr. Tan floated the idea of using the EndoGlide for donor corneas precut and preloaded by the eye banks. "It would make surgery simpler and much faster, and also help with re- imbursement issues," he explained. "One of the problems with these disposable inserters is that surgeons have to come out of pocket to pay. Now it can be part of the eye bank processing fee." Video symposium: Challenges, complications, common sense Capsular tension rings (CTRs) are useful, but "unexpected issues" can Chee Soon Phaik, M.D., Singapore occasionally crop up, said Arup Chakrabarti, M.D., Trivandrum, Kerala, India, speaking at a video symposium on Cataract Complica- tions and Challenges on the last day of the APACRS meeting. In one of the cases Dr. Chakrabarti presented, he was surprised to find that one of the eyelets of the CTR he was about to implant was broken. The sharp ends of the broken eyelet could easily have caused a capsular tear or damaged other parts of the eye. Fortunately, he noticed the defect as soon as he took the CTR out of its packaging. It is important to closely scrutinize each instrument under the surgical microscope before im- plantation, he said. In another case, Dr. Chakrabarti had problems with the injector he was using to implant a CTR. Using an injector is often preferable to implanting a CTR man- ually, particularly in cases with deep anterior chambers in which it might be difficult to maneuver the CTR into the bag. However, in this case, he noted a "bizarre pattern of CTR exit," with the CTR wobbling and bending back and forth as he pushed it out of the injector. Along with checking the quality of the CTR itself, Dr. Chakrabarti noted the importance of keeping the injector well maintained; to that end, he sug- gested that disposable injectors may provide a solution. In the same sym- Vincent Lee, M.D., Hong Kong posium, Chee Soon Phaik, M.D., Singapore, demonstrated various techniques she uses to manage dislo- cated IOLs. These techniques in- clude posterior assisted levitation, anterior assisted levitation, and forceps delivery. Dr. Chee's current preferred approach is to retrieve and reposition the IOL. She prefers a "bagless" approach, using a vitrector to remove the bag. Finally, she stabilizes the repositioned IOL with iris sutures. Edmund Wong, M.D., Singapore, a vitreoretinal surgeon, demonstrated an alternative way of securing an IOL in the posterior chamber without a bag: scleral tun- nel fixation. The technique requires a three-piece IOL. The haptics are exteriorized through scleral flaps and then inserted into tunnels made under the sclera using a small gauge needle—Dr. Wong has been using a 27 G needle but said that he is con- templating using a smaller gauge. The haptics are further secured with sutures and the flaps are folded back down over them. In a small series, patients generally appear to do well, although Dr. Wong and his col- leagues have seen a few complica- tions, including mild corneal edema, pupil capture, and thinning of the scleral tunnel. This final complica- tion is why Dr. Wong recommended that surgeons create the tunnels under a thick layer of tissue. Since Michael Knorz, M.D., Germany the technique requires some vitreous base trimming, Ronald Yeoh, M.D., Singapore, noted that it might not be advisable for cataract surgeons who have not had any experience performing procedures in the back of the eye. Mohan Rajan, M.D., Chennai, India, ended the sympo- sium with the cataract surgery equivalent of a blooper reel, show- ing a series of "freak accidents" that he said can happen to anyone while performing surgery. The first cases he presented happened to Dr. Rajan's residents, but the last few— including a post-keratoplasty cataract patient in whom the graft's integrity was compromised and cases in which the phaco and chop- per tips broke off inside the eye— happened in surgeries Dr. Rajan was performing himself. The take-home message, he said, is that these things happen; successfully dealing with these freak accidents when they do occur has little to do with how bril- liant or competent you are, and more to do with your ability to remain calm and use your common sense. Haike Guo, M.D., China, and Pannet Pangputhipong, M.D., Thailand, both of whom also presented videos, chaired the sym- posium together with Dr. Yeoh. EW

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