EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
Issue link: https://digital.eyeworld.org/i/78716
120 EW MEETING REPORTER March 2012 Reporting live from the 2012 ASCRS Winter Update meeting, Riviera Maya, Mexico EyeWorld covers the 2012 ASCRS Winter Update meeting in Riviera Maya, Mexico Friday, February 17 "Make the call" on complications David F. Chang, M.D., clinical pro- fessor of ophthalmology, University of California, San Francisco, who spoke at the 2012 ASCRS Winter Update in Riviera Maya, Mexico, presented seven cases and asked panel members to "make the call" in these complicated cases. Audience members were able to weigh in with their opinions on the cases via elec- tronic polling during this highly participatory session. In one case, R. Doyle Stulting, M.D., Woolfson Eye Institute, Atlanta, and Eric D. Donnenfeld, M.D., co-chairman, Cornea, Nassau University Medical Center, East Meadow, N.Y., discussed what to do with a 57-year-old post- op patient who had an anterior chamber tear and decided explant- ing the lens was the best option. Dr. Chang showed a video clip of the procedure, and the surgeons dis- cussed what new lens to implant and where. "You always want to go with a three-piece with a case like this," Dr. Donnenfeld advised. "If you put it in the sulcus, you want to sink the optics." Dr. Chang said in- stead, he opted to put the lens in the bag. "There was no fibrosis. The bag opened up pretty easily," he said. Corneal aberrations remained, but the optics were better in the end, Dr. Chang said. "This is a woman who immediately post-op was happy," he said. "She was very grateful that we did something other than LASIK." Peel away this problem Editors' note: This Meeting Reporter contains original reporting by the EyeWorld news team from the 2012 ASCRS Winter Update Meeting in Riviera Maya, Mexico. Addressing an often overlooked Salzmann's nodule is critical before cataract surgery because it will im- pact IOL choice, said W. Barry Lee, M.D., Eye Consultants of Atlanta, during the mid-morning cornea ses- sion. "These will affect your results, both refractive and uncorrected out- comes," he said. "I typically remove the nodule first and wait for the pa- tient to stabilize before doing the cataract surgery." The elevated mass can be easily peeled off, Dr. Lee said. "If you find the plane, the tip will just peel away," he said, pointing out that one patient he had was 20/80 before the lamellar procedure and 20/30 after and moved from 4.6 D of astigmatism to 1.2 D. "It's a huge change in the corneal topogra- phy just from removing that Salz- mann's nodule," he said. "This will impact your IOL selection, so this case really underscores the impor- tance of dealing with this before your cataract removal." Posterior corneal dystrophies are often over- looked as well, Dr. Lee said. "I still see these commonly missed in pa- tients who are unhappy after cataract surgery, where the surgeon has missed the guttata," he said. "That has led to either thickened corneal stroma, or simply the guttae in the visual axis are causing a blur in the vision. If you can pick these up beforehand, it really helps out with your patient expectations. Sometimes these things are easy to miss, but I urge you to put the slit lamp on high magnification and look at the corneal epithelium on all patients before you do their cataract surgery." Addressing astigmatism Although many surgeons are happy to stick with implanting toric lenses for astigmatic correction, two sur- geons said at a lunchtime symposia that peripheral corneal relaxing incisions (PCRIs) should remain a necessary part of a surgeon's arma- mentarium. "It's a worthwhile tech- nique to know, but we still don't