Eyeworld

38 | EYEWORLD | SEPTEMBER 2019 ATARACT C by Maxine Lipner EyeWorld Senior Contributing Writer "Dexycu is a sustained-delivery form of dexamethasone that is placed intracamerally in the posterior chamber of the eye, typically at the end of surgery," Dr. Hovanesian said, add- ing that the body will slowly absorb the dexa- methasone as it is continuously released over a 1-month period. It provides an anti-inflamma- tory effect comparable clinically to topical Pred Forte (prednisolone acetate, Allergan) taken 4 W hile many patients who have undergone cataract and other intraocular surgery are asked to take a plethora of drops post- operatively, the newer approach of injecting the FDA-approved Dexycu (dexamethasone intra- ocular suspension 9%, EyePoint Pharmaceuti- cals) can simplify things for patients, according to John Hovanesian, MD. Dr. Wiley said in cases of loose zonules, passing the loop behind the lens may further weaken the zonules. "This can be detected when engaging the loop prior to rotating the loop behind the lens," Dr. Wiley said. "If the zonules are loose the miLOOP can be aborted without causing damage." Dr. MacDonald has found miLOOP is safer in pseudoexfoliation cases than the use of standard phacoemulsification. "It is a gentler force when you are putting the miLOOP in and it's not stretching the bag," Dr. MacDonald said. "When you are cracking the nucleus, inward forces are being created, so miLOOP is not straining the zonules at all, and it is probably more zonular friendly than any divide and conquer or chopping technique." A challenge Dr. MacDonald has found with the device came when teaching surgeons who are hesitant to put something into the capsule and allow it to blindly find the way. "That is the one piece of the learning curve to understand," Dr. MacDonald said. "If you follow the directions, you're not going to pierce the capsule. The material has been polished, and it is very smooth and is not going to rupture the capsule." The second issue is that sometimes when surgeons cut the nucleus and it is very dense, the lens tries to pop into the anterior chamber. Dr. MacDonald uses a second instrument in such cases to hold the nucleus back while she is cutting it. Simplifying surgery with Dexycu continued from page 36 FLACS use Dr. Wiley said he has successfully used the miLOOP device with Zepto (Mynosys Cellu- lar Devices), with the combination providing capsulotomy and lens fragmentation results that rival those provided by the use of a femtosec- ond laser. "The miLOOP is more effective at lens fragmentation when compared to femto since it can bisect the lens from equator to equator, where the femto only fragments the lens in its central core," Dr. Wiley said. Dr. Garg does not think that the use of miLOOP in combination with an automated capsulotomy device will replace FLACS. "With FLACS we are able to treat concom- itant astigmatism," Dr. Garg said. "Combining miLOOP with automated capsulotomy does not treat astigmatism." Drs. MacDonald and Wiley said they have used the miLOOP on all types of cataracts, although Dr. Garg was unsure the miLOOP would get around an extremely large cataract, but to date has not had any issues with respect to this. In terms of anterior chamber prolapsed lens prevention, Dr. Garg generally stabilizes the lens with a second instrument (chopper/ spatula) when performing a bisection. If prolapse is not prevented, Dr. MacDon- ald puts viscoelastic into the eye, puts the lens back into the insertion guide and emulsifies. continued on page 39 PHARMACEUTICAL FOCUS

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