Eyeworld

MAR 2020

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

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34 | EYEWORLD | MARCH 2020 O NSITE Elizabeth Yeu, MD, Norfolk, Virginia, dis- cussed the evolving approach to astigmatism management, providing a number of pearls. Pearl 1: Identify real vs. false causes of corneal astigmatism. Pearl 2: Confirm quality using Placido disc topography; confirm quantity (axis, amount) with at least two devices. Pearl 3: Remember refractive astigmatism is more than what is in the anterior cornea. Pearl 4: Take advantage of advanced on- line toric calculators and toric IOL formulas. Pearl 5: When available, choose a toric IOL over LRI/AK to correct for corneal astigmatism. Sumit "Sam" Garg, MD, Irvine, California, shared pearls about intraoperative floppy iris syndrome (IFIS). Pearl 1: Ask the right questions. You want to know if your patient is at risk for IFIS, so go through the chart and ensure they're not on certain medications. Tamsulosin and alpha blockers can be associated with IFIS. Pearl 2: Be prepared. When you go into these cases, have the things you think you might need in the room and available to you. Dr. Garg likes to do a "squirt test" to see if the "iris is jumping a little bit." He also recommended iris expanders. Pearl 3: Incision management. Dr. Garg recommended anterior incisions, a longer inci- sion, and a low threshold to suture. Pearl 4: It's not just for men. IFIS may occur in females as well, Dr. Garg said. Alpha blockers are used for benign prostatic hyperplasia, but they are also used for urinary retention in women, and they're commonly used for kidney stone management. Pearl 5: Pressure management. You want to make sure the pressure is equal- ized, Dr. Garg said, mentioning gradient, hydrodissection, and low-flow phaco. He said it's also important to come off the infusion before coming out of the eye. Nathan Radcliffe, MD, New York, New York, presented pearls related to MIGS. • Use trypan for visualization. This can be used to stain the trabecular meshwork as well as the capsule. • "New stents on the block." Dr. Radcliffe mentioned both the iStent inject (Glaukos) and the Hydrus Microstent (Ivantis) as good options. • There's room in every practice for both stent and non-stent options. Dr. Radcliffe also mentioned endoscopic cyclophotocoagulation (ECP) for combo pro- cedures and the XEN Gel Stent (Allergan) ab externo. Pearls for the Hydrus Microstent from Manjool Shah, MD, Ann Arbor, Michigan, include: • Use a separate incision. It's helpful to be 4 clock hours away from the intended entry. • A small paracentesis helps you maintain the chamber and allows you to rotate the eye a bit. • Know your anatomy. A long, rigid, misaligned stent can be trouble. • Engage the canal at an upward angle and flatten out as the stent is deployed. This helps prevent posterior dives. James Davison, MD, Marshalltown, Iowa, delivered the Crandall Lecture, sharing some of the history of phaco and IOLs. Both were new technologies when Dr. Davison first got into ophthalmology. He called them an "actual paradigm shift," noting that many people were against them. At this time, there was a big bang, explosive pace of ideas, with symbiotic contributions by surgeons and industry R&D, he said. Dr. Davison discussed the history of IOL development, beginning with Sir Harold Ridley, MD, and the history of phaco, noting Highlights from ASCRS Winter Break Park City, Utah, Jan. 30–Feb. 1, 2020 Sumit "Sam" Garg, MD Manjool Shah, MD

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