Eyeworld

DECEMBER 2021 | EYEWORLD | 13 fixation. She also said that the possibility of using Gore-Tex sutures made her nervous in this patient, so she decided against it. She had to think if it was better to leave this monocular patient aphakic and not try to preserve the bag, which is what she ultimately decided to do. "This was a case where I didn't have all the answers," she said. There were certain things she was trying to accomplish, namely not losing nuclear material in the back of the eye and try- ing not to cause retinal tears. The age of the patient is also a factor in the decision-making process. For a younger patient, Dr. Al-Mohtaseb said she might be more likely to try to save the bag but thought her chosen option was good for this older patient. After addressing the remnant material, Dr. Al-Mohtaseb discovered that the patient also had a vitreous hemorrhage underneath. At this point, she was wondering about doing Yamane vs. leaving the patient aphakic. But when she saw the vitreous hemorrhage, she thought it would be better to leave the patient aphakic and see what the visual potential was and if there was inflammation. Dr. Al-Mohtaseb said this case demonstrates how a surgery can involve a decision tree of tough choices. ASCRS Grand Rounds recap ASCRS Grand Rounds, a regular CME opportunity for ASCRS members, is hosted in partnership with major academic institutions, featuring two challenging cases with panel discussions. Here's a recap of the cases featured in the September edition of the series presented by Wills Eye Hospital. Case 1: Rakhi Melvani, MD, PGY-4, shared a case involving a 77-year-old female who presented with progressively blurry vision in both eyes. She had uncomplicated cataract surgery 10 years prior but noticed a progressive decrease in vision within the 2 months before to coming to the clinic. She described a constant "film" in both eyes. Her prior annual exams with an outside provider were normal. She had a YAG capsulotomy with no improvement in vision for either eye. Her other medical history included diabetes and hyperten- sion. She was on neomycin/polymyxin B/dexamethasone ophthalmic ointment, as needed. Her refraction was 20/30 in the right eye and 20/50, pinholing to 20/ 40, in the left eye. Her pupils were equal, round, and reactive. Her pressure, motility, and anterior exam were normal. A clinical photograph showed her IOL in the left eye had numerous opacities. The examination found the opacities were within the IOL itself. Case 2: Marisa Schoen, MD, PGY-4, presented the case of a 64-year-old male who was referred to the clinic with decreased vision in his right eye, describing it as "muddy" with light sensitivity. Forty-years prior, he had been hit with a hockey stick in this eye. His right eye visual acuity was 20/400, and left was 20/20. His right pupil was irregular, dilated, and non-reactive with a 2+ anterior pupillary defect. Slit lamp examination revealed a dense, hypermature, cataract that was subluxated with at least 4 clock hours of zonular de- hiscence. There was a limited view of the fundus, but a B-scan was conducted. Biometry with the IOLMaster 700 (Carl Zeiss Meditec) was unable to obtain an axial length for the right eye; A-scan determined an axial length of 26.67 mm, which was different than the patient's left eye. Corneal thickness was greater in the right eye than the left, as was anterior chamber depth. Lens thickness was less in the right eye than the left. For more on how these cases were diagnosed and treated, as well as relevant clinical pearls, watch the full Grand Rounds video at ascrs.org/clinical-education/grand-rounds. Previous Grand Rounds episodes are available in the archives on the website.

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