EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
Issue link: https://digital.eyeworld.org/i/115557
142 EW MEETING REPORTER Reporting live from ASCRS•ASOA Winter Update 2013, Aventura, Fla. March 2013 Reporting live from ASCRS•ASOA Winter Update 2013 Friday, February 15 The function of the capsule in cataract surgery To kick off ASCRS•ASOA Winter Update 2013, the first morning general session for physicians was a "Video Symposium of Challenging Cases & Complications Management During Cataract Surgery." Rosa Braga-Mele, M.D., Toronto, detailed how she examined her 85-year-old female patient with no history of glaucoma and no signs of pseudoexfoliation who had a small pupil at the time of surgery that would not dilate further. Dr. Braga-Mele used both staining with trypan blue ophthalmic solution and viscoelastic and said she noticed that the nucleus or lens possibly was loose. Ultimately, she said she decided to remove the capsule completely and posed the question to the other panelists of whether or not they would take a similar course of action. Robert H. Osher, M.D., Cincinnati, said leaving the capsule in with no support would cause it to crinkle up, leaving it useless. "Either use the capsule or get rid of the capsule," he said. Dr. Braga-Mele said she removed the capsule because there was no stability. She decided to implant an anterior chamber IOL, though she noted that this decision may have been different for a younger patient. "I'm a big believer in trying to use the capsule," Dr. Osher said. "The capsule is a great friend if you feel comfortable with it." However, Dr. Osher said that it's most important to minimize risk and to do the safest thing. Editors' note: This Meeting Reporter contains original reporting by the EyeWorld news team from ASCRS•ASOA Winter Update 2013. Editors' note: Dr. Braga-Mele has financial interests with Abbott Medical Optics (AMO, Santa Ana, Calif.) and Alcon (Fort Worth, Texas). Dr. Osher has financial interests with Abbott Medical Optics, Alcon, and Bausch + Lomb (Rochester, N.Y.). Old friends and new friends gather together during the Welcome Reception. Managing premium IOL complications sparks debate Two video cases presented demonstrated different complications encountered with premium IOL implantation, emphasizing how the details of such cases matter. In the video session, moderated by Dr. Osher, Brock K. Bakewell, M.D., Tucson, Ariz., and David F. Chang, M.D., Los Altos, Calif., presented separate cases of patients who had premium IOL implantation by another surgeon. Dr. Bakewell overviewed a case of an 81-year-old male who was unhappy for four years with a ReZoom (AMO) lens in one eye and fine with an AcrySof ReSTOR IOL (Alcon) in the other eye. The ReZoom was shown to be temporally decentered with apparent zonular damage from 7 to 12 o'clock. "I think it was [decentered]. When I got the operative report, I think there was zonular dehiscence there, and he should have had a ring put in at the time of the original surgery," Dr. Bakewell said, in response to a question from panelist Stephen S. Lane, M.D., University of Minnesota, Minneapolis, about the pa- tient's basic dislike of the lens from implantation, which could have called for a lens exchange. Following recentering the lens using an Ahmed capsular tension segment (FCI Ophthalmics, Marshfield Hills, Mass.), the patient was pleased with the results, with no shadowing or "twinkling lights" issues. After Dr. Bakewell's presentation, a lively debate arose over the question of how to best perform centration. "Here you showed [premium IOL patient satisfaction], and this one came down to centration," Dr. Osher said. "Centration does matter, and we go to great lengths sometimes to make sure the lens is centered." Dr. Chang presented a case of a 48-year-old with chronic iridocyclitis with one eye phakic and with posterior synechiae. The patient had undergone phacoemulsification and ReSTOR lens implantation, and complained of poor visual acuity, including blurry vision. Following a two-month toric soft contact lens trial, Dr. Chang performed an IOL exchange with a Tecnis (AMO) lens and then YAG capsulotomy, and the patient was pleased with the results, he said.