Eyeworld

44 | EYEWORLD | JANUARY/FEBRUARY 2020 RESEARCH HIGHLIGHT ATARACT C by Liz Hillman Editorial Co-Director While most current formulas estimate ef- fective lens position through different variables, Dr. Castro-Alonso said any parameter that can improve this estimation optimizes power calcu- lations and can improve refractive results. For Dr. Castro-Alonso, the research stemmed from an observation. "For awhile, I was observing the final position of the lens with respect to the preop- erative image of the echogram. I superimposed the echogram in pseudophakic mode (where the actual position of the lens can be seen) on the preoperative echogram and checked that the anterior side of the lens was postopera- tively located in a position close to the point corresponding to the interface between the cortical-epinucleus complex and the crystal- line nucleus in those patients who underwent cataract surgery," he explained. "This point E stimated effective lens position (ELP) after IOL implantation remains a source for IOL power calculation errors because these predictions are not always accurate. There are efforts, however, to improve accuracy of this estimate, which approximates the IOL's final position in the eye. Recent research proposes two new parameters to improve ELP estimates: the intracrystalline interphase point (ICIP) and lens equatorial plane (LEP). Francisco Castro-Alonso, MD, said that "finding ocular parameters that help us estimate the final position of the intraocular lens after phaco refractive surgery is fundamental in the IOL power calculation." ICIP, defined by Dr. Castro-Alonso, is the point representing the interphase between the cortical-epinucleus complex and the nucleus. Possible new parameters to improve effective lens position estimates About the doctor Francisco Castro-Alonso, MD Head of ophthalmology Hospital of Alcañiz Alcañiz, Spain help. In high-risk cases, he advised emphasizing to parents the importance of returning for all postoperative exams due to the potential of needing to return to the OR. Positive signs Dr. Wilson found many of the results from the study promising. "We had 1,392 eyes, and yet we saw very little pupillary block glaucoma," he said, adding this was true even though in pediatric care peripheral iridotomies are not performed. Dr. Wilson was pleased there were no cases of endophthalmitis and there were few cases of elevated IOP (n=11), most of which were managed medically. Likewise, there were just seven inflammatory membranes found. Vitreous wick occurred six times, but there were no reoperations for this situation after the first year of life. For cases where vitrectomy is required within the first year of life, Dr. Wilson recommended using diluted triamcinolone to vi- sualize the vitreous. Dr. Wilson also pointed out that there were no returns to the OR for wound leaks found, something he attributes to the fact that all wounds are sutured in pediatric cases. Overall, Dr. Wilson views the study as an important resource. "The bottom line is that now we have numbers that are reliable that surgeons can quote to parents who want more information," he said. continued from page 42 Vitreous strand to the cataract wound Source: M. Edward Wilson, MD

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