JAN 2013

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

Issue link: https://digital.eyeworld.org/i/104833

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Page 13 of 70

January 2013 Femtosecond Spatulas 1 8- 05- IOL in proper position post-op low-up email, Dr. Lane did add that he has done ROC "twice with good results and no iris chafe." I do have the personal experience of having treated six cases of pseudophakic reverse pupillary block that caused contact between the iris and IOL leading to iris chafing and pigment dispersion. I reported and discussed this phenomenon in the ASGR column of the January 2012 issue of EyeWorld, "Reversal of misfortune." All patients were vitrectomized high myopes (as is the case here) so I believe that if one wishes to consider ROC in a vitrectomized high myope, one should also consider placing a peripheral iridotomy to prevent the possibility of reverse pupillary block occurring, which could lead to the iris being pushed back against the optic, leading to chafing. In this case I chose to simply wait five weeks and reposition the lens. My own experience is that if you reposition the lens immediately, it is very likely to rotate again. If, on the other hand, you wait a few weeks for some fibrosis to occur, the bag will shrink wrap a bit around the lens, and the lens will not rotate a second time. Although a CTR could have been used, I discussed the option with the patient who wished not to have one placed unless I felt it was absolutely necessary. In this case I did not feel that it was so we chose not to use it. The patient ended up with a 20/30 final outcome and no repeat rotation (Figure 2). One does not want to wait so long that the haptics become so strongly fibrosed in place that they are impossible to free up but long enough that there is some b : Sei 70 07 61 :S 72 itani el*, T e ib e l* ta ,S e inl ss um Source (all): Steven G. Safran, M.D. shrink wrapping of the bag around the lens so that the lens is not likely to rotate a second time. Although we don't know the exact timeframe for this, it is likely that waiting five to six weeks post-op from the original cataract surgery is a pretty safe play. One tip is that if you know the axis the lens is at, you don't need to mark the patient sitting up. For example, in this case the lens was measured at an axis of 67 degrees at the slit lamp, so I simply made a mark 33 degrees in the counterclockwise direction under the surgical microscope knowing that this would be exactly 100 degrees and then I rotated the lens to this point. I like to use a flat tip LASIK cannula (Katena K7-5106, Denville, N.J.) to get under the edge of the anterior capsule and initiate viscoelastic dissection. When you reopen the bag there is no need to "hyperinflate" with viscoelastic but rather to reopen just enough to easily facilitate rotation. The capsular bag exhibits a slightly different stiffer feel at six weeks out then it does at the time of initial cataract surgery due to fibrosis, and I believe this is what prevents the lens from rotating again. After rotation the viscoelastic is removed and the case is completed. Again, the CTR turned out not to be necessary. If I were to treat a patient who was not willing to consider waiting 4-6 weeks for a rotation then I would definitely use a CTR, but if you can wait a bit to do the repositioning, a CTR is probably not needed. If this lens were to rotate again, I would consider continued on page 14 8 7 2 -L -1 6 1 g : Le e */ el S ei b tai *, S n l es 73 61 -1 8 s s ou :R se n tai , *S au s les less Stain bel*, Sei tas*/ Stra 178: 8-16 *, bel Sei r*/ e exl s :W les 179 Stain 16 8- Call 727-209-2244 For More Information. /R 6ISIT WWW2HEIN-EDICALCOM 3360 Scherer Drive, Suite B, St. Petersburg, FL 33716 s 4EL s &AX %MAIL )NFO 2HEIN-EDICALCOM s 7EBSITE WWW2HEIN-EDICALCOM $EVELOPED )N #OORDINATION 7ITH "ARRY 3 3EIBEL -$ "ARBARA ,EGE -$ 0AUL " 2OUSSEAU "YRON ! 3TRATAS -$ 3TEPHEN ! 7EXLER -$ 1323 Rev.C ,UCAS 4HE %LDER 6ENUS #UPID BABC

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