Eyeworld

MARCH 2020 | EYEWORLD | 35 O Douglas Koch, MD, Houston, Texas, dis- cussed how to manage rotated toric IOLs. He noted three causes of residual ametropia: misalignment of the IOL with correct spherical power and toricity, inaccurate IOL toric power, and inaccurate IOL spherical power. Options to address these issues can be IOL based (rotation, exchange, or piggyback IOL) or cornea based (relaxing incisions, excimer laser ablation, or SMILE). If the spherical power is off, Dr. Koch said the excimer laser can be used, especially if it's a small correction. He will use this with up to 1.5 D of myopia or up to 1 D of hyperopia. For larger residual error, Dr. Koch said an IOL exchange may work better, but he noted that this may not be covered by insurance. The patient may insist on this if they think they have the wrong lens in their eye. Dr. Koch said he likes to use relaxing incisions when patients have a small amount of residual astigmatism. Nicole Fram, MD, Los Angeles, Califor- nia, offered her top five pearls for neuro- trophic keratitis: 1. Determine etiology. Take a thorough history. 2. Look at the medications. Dr. Fram recom- mended changing topical medications to preservative free. 3. Use amniotic membrane early in refractory disease. 4. Evaluate and treat abnormal eyelid anatomy and disease. 5. Know when a tarsorrhaphy is necessary and act quickly to avoid corneal thinning. Editors' note: Some of the physicians have financial interests with ophthalmic companies. its invention by Charles Kelman, MD. Dr. Da- vison mentioned a number of surgeons in the field who he worked with and those who made advancements in lenses and techniques. He noted some of his own contributions, including a variation to make different size lenses (either shorter or longer). In his lecture, Dr. Davison called ophthal- mologists "some of the luckiest people in the world." Phaco hacks from Robert Cionni, MD, Salt Lake City, Utah, include: • Dr. Cionni only hydrodissects one small area, and that's usually all you need. If one wave doesn't do it, Dr. Cionni will decompress and put in more fluid and decompress again. • Dr. Cionni likes pre-chop because everything is already broken up, and you haven't used any fluid or energy. • Dr. Cionni uses a one-handed technique. He doesn't recommend a second instrument unless you need it, finding it creates only one area for fluid egress, better stability, and a more efficient procedure. • Dr. Cionni generally doesn't have to move the tip much. If things are coming to it, there's no need to do manipulation. • Dr. Cionni suggested that if you have trouble with tremors during surgery, use your second hand to put the index finger right at the inci- sion. Douglas Koch, MD James Davison, MD

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