Eyeworld

C Contact information Name: by Name piece IOL in the bag. If there is a focal posterior capsular tear with intact zonules, he usually places a three-piece IOL in the sulcus with optic capture. However, if there is an anterior capsular tear that extends around posteriorly, especially if that tear occurs inferiorly, he prefers to not place the IOL in the sulcus because it is more likely to dislocate inferiorly through the zonular defect. In these situations, he arranges for a vitreoretinal colleague to per- form a pars plana vitrectomy, followed by his placement of a scleral-fixated IOL using the Yamane intrascleral haptic fixation technique. "Pseudoexfoliation is a global and progressive process where we can expect future weakness," Dr. Devgan said. "In many cases, nothing special may be needed, such as the situation of a nonagenarian patient with reasonable capsular support. This patient is likely to pass away prior to suffering late dislocation of the capsular bag-lens complex. In other patients, placement of a capsular tension ring can be helpful, but it will not prevent future weakening of the zonular support. You must tailor the approach to the patient." Overall, Dr. Rao said he thinks that residents should have direct experience inserting iris hooks and pupil expansion rings in training, but becoming proficient with capsular hooks, tension segments, and tension rings re- quires significantly more surgical experience. "If you don't feel comfortable rescuing the bag, there is nothing wrong with leaving the patient aphakic and referring them to an anterior segment surgeon experienced with these techniques," Dr. Rao said. "Just do a good ante- rior vitrectomy, if needed, and suture your main incision. I would not recommend putting in an anterior chamber IOL anymore. … It's better for the patient to be left aphakic for a few days or weeks and have a secondary IOL implanta- tion with a scleral-fixation technique once the eye settles down a bit." Dr. Devgan, who still teaches his residents how to use anterior chamber lenses, said, "A well-placed anterior chamber IOL can have the same visual performance of an iris-sutured or scleral-fixated posterior chamber IOL. Ul- timately the surgeon should have a wide range of options and do what is most compatible with the eye." I N S T R U M E N T S | S I N G L E U S E | D R Y E Y E | B I O L O G I C S Stephens Instruments | 2500 Sandersville Rd | Lexington KY 40511 USA Toll Free ( USA ) 800.354.7848 | info@stephensinst.com | stephensinst.com © 2019 Stephens Instruments. All rights reserved. Vera180™ synthetic absorbable lacrimal plugs from Lacrivera® provide extended temporary occlusion lasting approximately 6 months. Offer patients long-lasting relief while optimizing your patient treatment schedule. Stephens – more than instruments. Vera180 ™ Absorbable Lacrimal Plugs Look to Stephens for 6 month dry eye relief A Sinskey hook can be used to guide the leading eyelet of a capsular tension ring so it does not stress the weakened zonules during insertion. Source: Naveen Rao, MD

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