Eyeworld

73 November 2018 EW MEETING REPORTER Finally, Dr. Williamson stressed that some important postoperative considerations are to watch for early IOP spikes, use frequent topical steroids, watch for steroid response, look for early bleb failure, and con- sider anti-fibrotics. Editors' note: Dr. Williamson has financial interests with Glaukos (San Clemente, California). Dr. Singh has financial interests with a number of ophthalmic companies. Innovations and hot topics in cataract surgery The final session of Saturday's after- noon program highlighted a number of hot topics and innovations in cat- aract surgery. Julie Schallhorn, MD, San Francisco, shared information on uveitic cataracts. She mentioned that intraocular surgery can induce a uveitis flare, and inflammation can be very bad in these cases. It's important to control inflammation, she said, and you need to have an inflammation plan and a surgical plan. Before you operate, Dr. Schall- horn said that the general rule of thumb is that the patient has been quiet for 3 months and you're able to control flares. She said to keep patients on immunosuppressants during surgery and supplement with additional anti-inflammatories. She added that CME prevention is also important because CME is the number one cause of vision loss in uveitis. Since "anything can happen" when doing surgery with uveitic cataracts, Dr. Schallhorn said the important things to consider are visualization, the capsulotomy, your lens disassembly technique, and IOL choice. EW Editors' note: Dr. Schallhorn has no financial interests related to her presentation. intraoperative gonioscopy is not a substitute for slit lamp-based gonios- copy. Next, he said to know your angle anatomy. He also highlighted anesthesia use, indicating that topi- cal anesthesia is usually fine. Dr. Williamson discussed head/ microscope rotation, goniolens se- lection, hand positioning, the corne- al incision, the importance of good OVD fill, and goniolens docking. He suggested creating the corne- al incision just inside the limbus and noted that he uses cohesive OVD. In terms of goniolens docking, Dr. Wil- liamson said to align the light along the iris plane, not the corneal plane. Also during the glaucoma session, Kuldev Singh, MD, Palo Alto, California, shared several reasons why he thinks trabeculec- tomy will survive, despite the MIGS revolution: individualization of surgical goals, postoperative titration possible, proven long-term success, option of inferior drainage tube im- plant, and the aging population. In another presentation, Dr. Williamson shared some important information for cataract surgery in the post-glaucoma surgery patient. He offered preoperative, intraoper- ative, and postoperative consider- ations. Preoperatively, he said to evalu- ate bleb function, postpone cataract surgery if the patient has had a re- cent trabeculectomy (wait at least 6 months), use gonioscopy to view in- ternal ostomy of the trabeculectomy, beware of high IOP, assess pupillary dilation, and look for pseudoexfolia- tion/zonular stability. Intraoperatively, Dr. Williamson said to try to do as minimal manipu- lation as possible, avoid retrobulbar anesthesia, make incisions away from the bleb, avoid pupillary mi- osis, break posterior synechiae and pupillary membrane, use dispersive OVD to protect the endothelium, beware the shallow anterior cham- ber, remove all cortex to prevent inflammation, don't break the bag, avoid a multifocal in these end-stage patients, and remove OVD behind the lens.

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