Eyeworld

OCTOBER 2019 | EYEWORLD | 35 C Contact information Ayres: brandonayres@me.com Fram: nicfram@yahoo.com Safran: safran12@comcast.net Weikert: mweikert@bcm.edu a vitrectomy before you put that lens into the anterior chamber is important just to make sure there is no vitreous traction." Dr. Fram pointed out that ASCRS provides wet lab trainings for anterior and pars plana vitrectomy. If you are a novice with this, how- ever, she said starting these cases with a fully vitrectomized eye or performing the case with a retina specialist is helpful. Dr. Safran also advocated for pars plana vitrectomy because he said the manipulations of the Yamane technique are behind the iris. "Peripheral iridotomy." "PI at the end of the case." Dr. Safran said it's a "critical step" to make a peripheral iridotomy (PI) with a vitrector in order to avoid reverse pupillary block; it's something he does on every Yamane case. He makes the PI on the temporal side because it causes less monocular diplopia. Dr. Safran said it's important to engage the iris with the cutter on (vs. aspiration) so as to not make too large of a PI. Some high myopes, he noted, may need more than one PI. "Redocking the haptic if the IOL is decentered." If the lens is decentered while performing the Yamane technique, so much so that haptic trimming won't correct it, Dr. Safran said he re- docks the haptics to achieve perfect centration. If the sclerotomy positions, for example, are causing the decentration, Dr. Safran said one should create a new sclerotomy in the correct position, grab the haptic pulling it back into the eye, and redock the haptic into your new needle pass. "Doing pars plana anterior vitrec- tomy before bringing through the IOL/bag complex into the AC." "Even in patients who have already had a vitrec- tomy, be ready for more vitrectomy," Dr. Ayres said. To comfortably manage a subluxated IOL or IOL exchange, Dr. Ayres said it's essential to perform pars plana incisions. "I don't think these cases are well managed if you can only use the anterior segment," he said. "You've got to be able to lift these lenses, and I think doing Watch the webinar The full webinar— "Management of Dislocated IOLs and Secondary IOL Placement: Yamane Technique" —can be found in the ASCRS Center for Learning, www.ascrs.org/ center-for-learning. Tips from Dr. Ayres •Being prepared in the operating room, both mentally and with the correct instrumentation, is essential for a good outcome. •Know the details of the IOL being removed and the IOL being placed. •Consider future surgical procedures and the impact this has on IOL selection and IOL fixation technique. •Have a backup plan in place in case "things happen." Dr. Weikert described where to place incisions, make markings, and the necessity of 20-degree needle angulation to allow proper haptic orientation. Source: ASCRS webinar screenshot

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