Eyeworld

14 | EYEWORLD | SEPTEMBER 2021 ASCRS NEWS T he Ophthalmology Quicksand Chroni- cles podcast, hosted by Elizabeth Yeu, MD, and Nicole Fram, MD, has fea- tured some interesting guests over the past couple of months. These experts shared their "quicksand moments" in the OR, lessons learned from those moments, and how these vulnerable situations ultimately helped them evolve as surgeons. "The Mature Intumescent Lens: Eye Cried For Me, Argentina!" Drs. Yeu and Fram welcomed Rosa Braga-Mele, MD, to share a case of a white cataract and the Argentinian flag sign. Dr. Braga-Mele said it was meant to teach a resident how to handle a white cataract. She stained the lens with trypan blue, noting that when she stains with this, she will put in a little viscoelastic, about half of the ante- rior chamber, then paint the trypan blue across. She refills with viscoelastic, and the trypan blue gets pushed to the side (about 0.1 cc will go into eye). Using a 27-gauge needle and overfilling the chamber with dispersive viscoelastic, Dr. Braga- Mele began decompressing the cortex. She was trying to avoid the chance of the Argentinian flag sign, but it happened, and she said she knew the exact reason why. As she was decom- pressing, the patient coughed. Dr. Braga-Mele said she uses "verbal anesthesia," warning the patient when she's going in with the needle and possibly sedating the patient a bit more. In this case, Dr. Braga-Mele decided to put in dispersive viscoelastic underneath the flaps, overfilled the chamber with viscoelastic, and impaled the lens to bring it up and out over the iris. She noted that she was removing the lens without chopping it because she wanted to be careful not to have any nuclear fragments float- ing around in case the posterior capsule was not intact. "The eye will always humble you," she said, adding that it's all about how you react to it. The key in situations like this is to not panic and to react appropriately, she said, recommending maintaining the chamber all the time to mini- mize the amount of damage. Dr. Braga-Mele put in the lens, which she let unfold in the anterior chamber to get it into place. Dr. Yeu pointed out that a three-piece lens may not be a good choice in this situation because there is too much positive pressure, and Dr. Braga-Mele agreed that she would use a single-piece lens. After the lens was in the bag, she hydrat- ed the incisions, noting that it's important to decrease the amount of decompression and use gentle, low-flow removal of viscoelastic. The patient ended up with a good outcome postop. "Humbling Hurdles of IOL Fixation" Brandon Ayres, MD, shared a case where he was asked to consult and perform surgery on a fellow eyecare professional whose multifocal IOL dislocated when he was hit with a rico- cheted golf ball. The patient loved the multifo- cal and wanted to keep it. The patient flew up from Florida and bought his own biometry and IOLs with him. At the slit lamp the day before surgery, the lens was clearly dislocated in the capsular bag. The plan was to do a pars plana vitrecto- my no matter what. Dr. Ayres put in a trocar to Ophthalmology Quicksand Chronicles recap continued on page 17

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