Eyeworld

64 | EYEWORLD | DECEMBER 2019 O NSITE EYEWORLD ONSITE SAN FRANCISCO OCTOBER 11–15, 2019 Barrett Universal II—which he said have the best refractive results for nearly all eyes—the Barrett True K for post-refractive eyes, and Barrett Toric (used with integrated K). Eric Donnenfeld, MD, Rockville Centre, New York, said femtosecond arcuate incisions are good for 1 D or less of cylinder. "What I want to create is a femtosecond arcuate incision that opens with a little difficulty," he said, explaining that he will open one on the table and wait a week before opening the other. Nicole Fram, MD, Los Angeles, described management of positive and negative dys- photopsias. Positive dysphotopsias, Dr. Fram said, consist of light, streaks/arcs, flashes, and starbursts, while negative dysphotopsias are temporal dark shadows. Positive dysphotopsias can be treated with pharmacological agents (brimonidine 0.15% or pilocarpine 0.5%) or removal and replacement with a different IOL material. Negative dysphotopsias, if they don't resolve over time, can be managed with reverse (anterior) optic capture or a sulcus-placed IOL. A piggyback IOL or nasal capsulectomy could be considered, she said. Clara Chan, MD, Toronto, Canada, discussed management of ocular cicatricial diseases, stressing the importance of staged manage- ment. Elizabeth Yeu, MD, Norfolk, Virginia, offered pearls for handling white cataracts: 1. Understand your opponent. 2. Decompress the nucleus before capsulorhexis. 3. Opening the anterior capsule may be the most difficult step. 4. Nuclear densities of white cataracts differ from eye to eye. 5. Vigilantly protect the posterior capsule. Kevin Miller, MD, Los Angeles, shared general observations from his experience working with artificial irises during his Charles D. Kelman Lecture. The color match is not always perfect, he said, and the iris does not always center in the eye, especially if it is suture fixated. The pupils of the two eyes will not match under all lighting conditions. Additionally, many of these eyes will require subsequent strabismus surgery. Some may also require penetrating or endothe- lial keratoplasty, and most will require blepha- roptosis repair. Glaucoma will continue to be a problem for eyes that had it preoperatively. But, on a positive note, Dr. Miller said the view of the retina and optic nerve through the artificial pupil is excellent. Yuri McKee, MD, Mesa, Arizona, presented on IOL calculations, and his "biggest piece of advice is to use an IOL calculation from this century." He recommended the Hill-RBF and Highlights from the 2019 AAO Annual Kevin Miller, MD, discusses a new implant for the treatment of iris defects. Nicole Fram, MD, discusses pearls for pre-, peri-, and postoperative management for toric IOL cases. H i g h l i g h t s f r o m E y e W o r l d T V a t A A O 2 019

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