APR 2013

EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.

Issue link: https://digital.eyeworld.org/i/119916

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Page 29 of 82

Seibel* Nucleus Choppers 6 451 8-1 A 8 45 -1 35 -R B R with significant refractive error. The key to success with this procedure is to be able to separate the anterior capsule from the lens optic with viscoelastic, and then viscodissect the entire lens away from the capsule. In some cases, the entire optic can be freed, but the haptic can be trapped, and it is fine to amputate the haptics with intraocular scissors. Following removal of the old IOL, the new IOL can be placed within the capsular bag. In some patients, there is residual astigmatism with a relatively plano spherical equivalent. These patients can potentially have AKs performed with either a diamond blade or a femtosecond laser. In general, all of these procedures are effective for reducing refractive error and are considered relatively low risk. Some patients may prefer to be prescribed spectacles or contact lenses rather than undergo additional surgery. An important condition that can cause a surprise moderate residual refractive error is Z-syndrome. This occurs with the Crystalens due to capsular contraction and is easy to treat when identified early. The main decision is whether to perform a YAG capsulotomy to release the capsular contraction or perform intraocular surgery with the placement of a capsular tension ring (CTR). In general, both YAG laser and placement of a CTR appear to have a good track record, so there is still considerable debate as to which procedure is optimal. Successfully handling patients with moderate refractive errors in their first eye by determining the cause of the residual refractive error and coming up with a treatment plan will result in happier patients, allowing the second eye surgery to proceed, with the ultimate goal of achieving good binocular vision for your patients. EW 814 53 6- ASCRS online Post-Keratorefractive IOL Calculator. In my practice, I have found that the Haigis-L formula works very well for my post-PRK or LASIK patients. While some patients will want to proceed with cataract surgery on the second eye, some dissatisfied cataract surgery patients with moderate residual refractive error in the first eye will prefer to delay second eye cataract surgery until the first eye is "fixed." Thankfully, there are many excellent options for reducing the refractive error in eyes following cataract surgery. In our practice, we tend to perform surface ablation or LASIK for patients with myopic or mildly hyperopic refractive errors who are eligible for such procedures. Since most pseudophakic patients are older and therefore have small pupils, one can consider performing conventional PRK with a smaller treatment zone (6.5 mm rather than 8.0 mm). One of the most important considerations when performing corneal refractive surgery on patients in their 70s and 80s is to understand that dry eye is extremely common, and there can be a risk of delayed epithelial healing. One might consider placing punctal plugs prophylactically, as well as be cognizant of the effects of using multiple medications, especially in patients who may be on other topical medications such as those for glaucoma. For hyperopic patients, we tend to lean toward piggyback IOL or IOL exchange procedures. Both of these intraocular procedures require a return to the operating room. While each surgeon has his or her own preference between piggyback IOLs and IOL exchange, I believe that most surgeons would lean toward a piggyback IOL if there is an open capsule. Piggyback IOLs are in general very simple to perform, as the placement of the new IOL in the sulcus is straightforward. However, it is important to use a different material for the piggyback IOL. For example, if the patient has an acrylic IOL in the capsular bag, then the piggyback IOL should be a silicone IOL. IOL exchanges have proven to be an effective treatment for patients Complete Vertical & Horizontal Chopping, Available In Stainless & Titanium " 6ERTICAL #HOPPING 8-14535-R: C ! (ORIZONTAL #HOPPING 8-14516: 05-4040: 8-14516-L: 8-14516-S: 05-4040-S: 8-14516-SL: Editors' note: Dr. Trattler has financial interests with Allergan (Irvine, Calif.), Abbott Medical Optics (Santa Ana, Calif.), Bausch + Lomb, and LensAR (Orlando, Fla.). Seibel Nucleus Horizontal Safety Chopper-Right Hand Dominant, Angled. Seibel Nucleus Horizontal Safety Chopper, AngledRight Hand Dominant Surgeon-Titanium. Seibel Nucleus Horizontal Safety Chopper-Left Hand Dominant, Angled. Seibel Nucleus Horizontal Safety Chopper-Right Hand Dominant, Straight. Seibel Nucleus Horizontal Safety Chopper, StraightRight Hand Dominant Surgeon-Titanium. Seibel Nucleus Horizontal Safety Chopper-Left Hand Dominant, Straight. 8-14535-L: Seibel Vertical Safety Quick Chopper, Right Hand Dominant. Seibel Vertical Safety Quick Chopper, Left Hand Dominant. # (ORIZONTAL 6ERTICAL #HOPPING 8-14536-L: 8-14536-R: Seibel Nucleus Horizontal Safety Chopper & Safety Quick Chopper, Left Hand Dominant. Seibel Nucleus Horizontal Safety Chopper & Safety Quick Chopper, Right Hand Dominant. Horizontal Safety Chopper Video Vertical Safety Quick Chopper Video 3360 Scherer Drive, Suite B, St. Petersburg, FL 33716 s 4EL s &AX %MAIL )NFO 2HEIN-EDICALCOM s 7EBSITE WWW2HEIN-EDICALCOM $EVELOPED )N #OORDINATION 7ITH "ARRY 3 3EIBEL -$ Contact information Trattler: wtrattler@gmail.com 9OUNG 7OMAN AT (ER 4OILET 4ITIAN 1314 Rev.B ACBD

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