EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
Issue link: https://digital.eyeworld.org/i/78716
132 EW MEETING REPORTER March 2012 Reporting live from the 2012 AGS annual meeting, New York sion." In contrast, Adam Reynolds, M.D., supports canaloplasty as his first-line procedure of choice in many clinical situations. His criteria for selecting canaloplasty over tra- beculoplasty include less severe glau- coma, a target IOP that is not extremely low, and widely open an- terior chamber drainage angles. He performs this procedure as far into the nasal quadrant as he can. "If it fails, I can always go on to tra- beculectomy later because I've spared the superior conjunctiva." Cataract surgery in the pseudoexfoliation syndrome eye It is well known that cataract surgery in eyes with pseudoexfoliation is fraught with peril. Not only are zonules often weak or disrupted, but the pupil often dilates poorly, fur- ther complicating the case by limit- ing visibility. Lisa Fran Rosenberg, M.D., discussed the various options for pupil management in these eyes. They include hooks, viscodilation, stretching tools, and the relatively new Malyugin Ring (MicroSurgical Technology, MST, Redmond, Wash.). She often uses the Malyugin Ring, and she shared a pearl for its re- moval at the end of the procedure: Cut the loop near the incision and pull gently to cause less wound dis- tortion. Ike Ahmed, M.D., shared that he prefers hooks in these eyes, as they can serve emergently as cap- sular hooks if needed. Robert Feldman, M.D., dis- cussed a variety of surgical options to consider when the natural lens is subluxed pre-op. These include stan- dard phacoemulsification with care- ful lens management, the use of capsular hooks to hold the bag in place, or a posterior approach via the pars plana that is usually de- ferred to vitreoretinal colleagues. For Dr. Feldman, the deciding factor is whether or not he hopes to save the capsular bag for IOL support. When he does opt for the pars plana ap- proach, he said it is ultimately faster, safer, and allows for more posterior placement of a tube if needed later in the course of the glaucoma disease process. He also places a cap- sular tension ring in all pseudoexfo- liation cataract cases, regardless of the ease of the cataract operation. "It is much easier to suture the lens back into position 5, 10, or 15 years later when it dislocates, as so many of these do," he said. When that does happen, Dr. Ahmed suggested, "It's best to intervene early. These cases do progress, and they only get harder to fix with time." Is cataract surgery an effective treatment for open-angle glaucoma? A panel of experts debated the role of cataract surgery alone for IOP reduction in the management of open-angle glaucoma. Anne Coleman, M.D., reviewed the cur- rent thinking on this important topic. "Several studies have evalu- ated the effect of cataract surgery in