JAN 2013

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

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Page 53 of 70

January 2013 EW RESIDENTS Figures 2 and 3: When the presumably completely torn capsule was removed, the incomplete tear instead went radial under the wound. hook to manipulate the iris to view the full extent of the tear. The priority is to prevent dropping the nucleus; extracapsular conversion should be performed at any time if needed. Marques FF, et al. found that nearly half of anterior capsular tears result in peripheral extension around the lens equator and through the posterior capsule. With a stable lens, however, I would carefully proceed with phacoemulsification. Extension of the tear can occur with anterior prolapse of nucleus, posterior pressure on the lens, or direct trauma to the capsule. All movements should be slow, controlled, and focused to prevent worsening of the tear. Perform both hydrodissection and hydrodelineation of the lens. An angled hydrodissection cannula, placed 90 degrees away from the site of the incision/tear, avoids the traumatic risk and assures that the hydrodissection wave does not end at the subincisional/tear area where it tends to be less complete. Be careful of capsular-lenticular block or any anterior movement of the nucleus. Hydrodelineation is crucial in this situation as it creates a protective epinuclear shell and separates out a smaller, central nuclear area to be removed first. The central lens needs to rotate freely prior to starting nucleofractis. My preference is to chop the lens nucleus; this is less traumatic and requires less lens rotation and posterior pressure on the lens. Since the capsule is intact contralateral to the wound, either horizontal or vertical chop can be performed. Placement of the horizontal chopper into the space created from hydrodelineation avoids capsular trauma. Lowering the phacoemulsification settings can create slower flow and decrease post-occlusion surge. Prior to removing the phacoemulsification tip from the eye, viscoelastic may be injected to keep the anterior chamber from shallowing. Removal of the epinuclear shell and cortex should start 180 degrees away from the capsular tear, and forces should be pulled toward the tear. If a good cortical cleaving hydrodissection wave was created, this step should not be excessively challenging. Leave the compromised subincisional area for the end. I would inject a one-piece, acrylic IOL into the bag if the posterior capsule was intact. The haptics should be placed 90 degrees away from the tear. This avoids traumatic extension of the tear and places the haptics in an area of capsular support should the tear extend through the center of the bag, which can often occur. If the posterior capsule is compromised, a three-piece sulcus IOL, with optic capture through the capsulorhexis, is the next best choice. Sutured or anterior chamber IOLs are other options if needed. After IOL placement, remove the viscoelastic without shallowing the anterior chamber. Lower the settings for viscoelastic removal or consider removal with an irrigating cannula through the paracentesis. Using acetylcholine and/or suturing the wound to assure watertight closure are other options to help prevent IOL or vitreous (if present) prolapse post-op. EW Reference Marques FF, Marques DM, Osher RH, Osher JM. Fate of anterior capsule tears during cataract surgery. J Cataract Refract Surg. 2006 Oct;32(10):1638-42. Editors' note: The physicians have no financial interests related to this article. Contact information Chiu: chiuc@vision.ucsf.edu Cohen: klc@med.unc.edu Tsai: Tsai@vision.wustl.edu 51 Source (all): Thomas Oetting, M.D. Art Contest helps launch web portal T he Connections in Sight coalition web portal is now serving the Southeastern Wisconsin community of more than 60,000 lowvision residents, launching with an art contest featuring low-vision artists from around the U.S. The Art Contest, which can be accessed at connectionsinsight.org/ art-contest/all-art-entries, is traveling around Southern Wisconsin as an art exhibit. Voters could choose different artworks created by low-vision artists including mixed media, jewelry, and paintings. The Connections in Sight web portal is a group of organizations that is looking to assist people with low-vision in quality of life issues, including maintaining and improving their daily lives. It is a resource for blind and visually impaired children, adults, and their families, providing information about varied topics including daily life, coping and information and research. "The portal will allow people to quickly and easily obtain helpful information regarding eye diseases and conditions, eye care, vision loss and low vision, available braille and recorded library materials, services for audio, digital and braille transcription, vision rehabilitation and training and employment opportunities," according to information provided by an official. "Connections in Sight also offers resources to help with daily life needs such as accessibility to eyecare products, transportation and creative in-home strategies." Connections in Sight can be accessed at www.connectionsinsight.org

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