EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
Issue link: https://digital.eyeworld.org/i/78716
122 EW MEETING REPORTER March 2012 Reporting live from the 2012 ASCRS Winter Update meeting, Riviera Maya, Mexico open angles who have a modest IOP target of 15-16 mm Hg, while trab or tube procedures remain for moder- ate to advanced disease in patients with open or closed angles and a low IOP target of less than 13 mm Hg. "The fact is, if we could get all of our patients in the mid-teens, we would solve a lot of the glaucoma problems we have," Dr. Lewis said. Technique makes scleral fixation easier Brock K. Bakewell, M.D., clinical assistant professor of ophthalmol- ogy, University of Utah, Salt Lake City, demonstrated the Hoffman pocket technique for scleral suture fixation, which he said he uses often to secure a Cionni capsular tension ring (CTR, Morcher, Stuttgart, Germany) and Ahmed capsular tension segment (Morcher). "It makes scleral fixation much easier," he said. "Always use a CTR with any sign of zonular weakness. It may be easier to suture fixate a dislocated CTR than a single-piece acrylic lens." With the technique, the surgeon creates a 350-micrometer incision with a micrometer blade on the cornea and tunnels back into the sclera, creating a 3.5-mm pocket where the CTR can be sutured under the sclera without cutting the con- junctiva. "Do not over tighten this because then you're going to decen- ter your whole bag CTR complex," he advised about the 9-0 prolene knot that is buried in the pocket. Use prophylaxis to reduce risk of CME before cataract surgery BEST Want the In Patient Education? Then look no futher. At Eyemaginations, we know what it takes to stay innovative and maintain the level of excellence that our clients demand in order to stand out among the rest. Simply, we have the best technology for the best value when it comes to patient education—no matter what the competition tells you. We offer: ƫ đƫ100% FREE Eyecare Apps for iPad with a variety of 7 to choose from including our all new LUMA Vision Simulator featuring on-screen drawing giving users the ability to annotate and markup images as well as view disease progressions and point-of-view scenes side-by-side. ƫ đƫOne low cost for ALL of our HD quality animations—you get everything we have to offer for one low price! ƫ đƫThe largest library of content available covering the most sought-after topics in the eyecare industry. So why settle for anything but the best? Visit us at ASCRS in Booth #319 to find out more. www.eyemaginations.com ƫƫćĀĀƫ /$%*#0+*ƫ 2!*1!Čƫ 1%0!ƫāĀĀƫđƫ (0%)+.!Čƫ ĉĈĈċăĂāċĆąĉāƫđƫ%*"+Į!5!) #%* 0%+*/ċ +) ƫĂāĂĀą Topical NSAIDs are effective in pre- venting post-surgical angiographic cystoid macular edema (CME); therefore, surgeons should treat high-risk patients with prophylaxis for 1 week prior to cataract surgery, according to one surgeon. "NSAID therapy also has been shown to have a beneficial effect on visual func- tion," said Terry Kim, M.D., associ- ate professor of ophthalmology, Duke University School of Medicine, Durham, N.C. CME is the most fre- quent cause of visual decline follow- ing uncomplicated cataract surgery, and it occurs in 3-12% of cataract cases, Dr. Kim said. He added that he continues NSAIDs for at-risk patients from 4 weeks to several months after surgery. Dr. Kim also said that using optical coherence tomography can measure subtle post-op retinal thick- ening and is gaining popularity for the diagnosis of CME. Uses for femtosecond lasers in cataract surgery Intrastromal ablations for the treat- ment of astigmatism with femtosec- ond lasers is an exciting new avenue for the emerging yet controversial technology, according to a surgeon who is one of the first in the world to use the lasers. "This is a work in progress," said Eric D. Donnenfeld, M.D., co-chairman, Cornea, Nassau University Medical Center, East Meadow, N.Y. "We're only on the tip of the iceberg right now in terms of where this technology will grow. There's a lot more to this than just capsulotomies and limbal relaxing incisions." Champions of femtosec- ond laser-assisted cataract surgery have pointed to being able to create a perfect capsulorhexis as a huge benefit to the technology. "Capsulo- tomy may seem like an area of small interest, but it is being shown this is the major reason we have surprises following cataract surgery," Dr. Donnenfeld said. The size, shape, and positioning of the capsulorhexis is key for determining effective lens position. "A 0.5-mm axial plane deviation from intended ELP results in 1 D of refractive error," Dr. Donnenfeld said. He added that femtosecond laser astigmatic kerato- tomies are now adjustable. Surgeons may create and partially open refrac- tive incisions at the time of cataract surgery. They may also use intraop- erative aberrometry (WaveTec ORA, Aliso Viejo, Calif.) to titrate their results in the OR. The follow- ing day, the patient can be exam- ined with topography and the surgeon may adjust the refraction at the slit lamp by opening the remain- der of the incision. Sunday, February 19 Talking dollars with sense With the introduction of premium lenses, ophthalmologists have found themselves thrust into the awkward role of being not only healers, but salespeople as well. That was one of the topics discussed at a highly interactive breakfast symposium Sunday at the 2012 ASCRS Winter