Eyeworld

N EWS 32 | EYEWORLD | APRIL 2019 by Ellen Stodola and Liz Hillman EyeWorld Senior Staff Writers Contact information Chang: ptchang@bcm.edu Dhaliwal: dhaliwaldk@upmc.edu Garg: gargs@uci.edu Weikert: mweikert@bcm.edu PRESENTATION SPOTLIGHT • Visualize the angle of the handle relative to the snare; angle up a bit (20 degrees). • Pass the snare under a stained capsule, main- taining the black ring on the instrument at the incision. As the snare is contracted, use a sec- ond instrument to apply pressure to the distal pole to keep the lens from rotating out of the capsule. • Recognize that the loop doesn't close complete- ly so you will need to carefully break the nuclear bridge. • When performing phaco, work in the plane of the lens and capsule and refill periodically with a dispersive viscoelastic to protect the corneal endothelium. Dr. Weikert said that he now sees dense lens cases that are 20/20 on postop day 1 after using the miLOOP. Dr. Garg described using miLOOP as a rescue technique. He encountered an extremely dense lens that he initially used the femtosecond laser on to create the capsulorhexis, LRIs, and fragmentation. When he tried to impale the lens with his phaco probe, despite the femto treat- ment, he couldn't. He attempted both vertical and horizontal chops as well as trying to groove the lens, and all were unsuccessful. At this point, he turned to miLOOP to segment the lens and pro- ceeded to phaco. Given the density of the lens, Dr. Garg felt that despite using the femtosecond laser, without the miLOOP, he would have had to convert to an extracapsular cataract extraction to complete this surgery. Deepinder K. Dhaliwal, MD, spoke about dense lenses as well. On dense lenses, she uses a stop and chop technique with a wide groove and horizontal chop. On denser lenses, she makes a deeper and wider groove and uses vertical chop. For the densest lenses, Dr. Dhaliwal recommend- ed miLOOP and showed a video of her first miLOOP case. Other pearls she offered included staining the anterior capsule; making an extra paracentesis; assessing the anterior chamber depth and using preoperative mannitol if it's shallow; keeping phaco energy far from the corneal endo- thelium by debulking the lens in the capsular bag; T he 2019 Surgical Summit included in- teractive video sessions that touched on various topics involving cataract surgery challenges, dislocated IOLs and IOL fixation, MIGS-related procedures, and more. Here are a few selections from those sessions. Managing dense cataracts with miLOOP Mitchell P. Weikert, MD, and Sumit "Sam" Garg, MD, spoke about using the miLOOP (Carl Zeiss Meditec) for dense cataract cases. "Ever since this came out, it has been my go- to for dense cataracts. I'm not one for hyperbole, but for me this has been a game changer," Dr. Weikert said, before presenting the case of a red brunescent cataract. Dr. Weikert offered several miLOOP pearls: • Stain the capsule. • Get an adequately sized capsulorhexis (approxi- mately 5 mm); using a capsulorhexis marker can be very helpful. • Hydrodissect thoroughly so the lens moves easily. • Understand how the miLOOP snare expands and contracts. Video highlights from the 2019 Surgical Summit Fully extended miLOOP illustrating the size of the snare and the angulation relative to the handle Source: Mitchell Weikert, MD continued on page 34 About the doctors Peter T. Chang, MD Associate professor of ophthalmology Cullen Eye Institute Baylor College of Medicine Houston Deepinder K. Dhaliwal, MD Professor of Ophthalmology University of Pittsburgh School of Medicine Pittsburgh Sumit "Sam" Garg, MD Medical director Gavin Herbert Eye Institute University of California, Irvine Mitchell P. Weikert, MD Associate professor of ophthalmology Cullen Eye Institute Baylor College of Medicine Houston Financial interests Chang: Allergan Dhaliwal: None Garg: Johnson & Johnson Vision, Carl Zeiss Meditec Weikert: Alcon

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