July 2013 Cataract challenges
make an error. "The bag can be so
floppy, it can come up to your
phaco tip," she said. Pulling out one
more time, even for a remaining
small piece, and filling up the bag
again can help avoid this, she said.
Use of a dispersive viscoelastic
in patients with dense cataracts
helps to protect the corneal endothelium, Dr. Bordewick said. "I
don't hesitate to use dispersive viscoelastic above and below the fragments I'm removing. Sometimes the
posterior plate is difficult to split. If
you take viscoelastic with a cannula
and a protective sleeve, you can inject visco under that plate and move
it forward away from the posterior
capsule. Then it's safer to remove it,"
she said.
You should also consider using a
CTR if necessary to make sure the
lens is well centered, said Dr. Kim.
Burned by phaco burns?
The surgeons interviewed have not
experienced phaco burn that often,
although it's always a risk, said Dr.
Bordewick. "It's obviously a concern
because you're typically using higher
settings and more phaco energy. I
use phaco in short bursts and add
some chopping to that to minimize
the amount of heat," she said.
Dr. Pettey had a phaco wound
burn referred to him not long ago,
and he followed the advice of Majid
Moshirfar, MD, professor of ophthalmology, University of Utah,
Department of Ophthalmology and
Visual Sciences, and in practice,
John A. Moran Eye Center, Salt Lake
City. "When the wound edges are
fish-mouthed, you need something
to fill the void created by wound
edge contracture. My last case had a
large wound gape, and rather than
suture down the edges tight with
resultant 10 or fewer diopters of
cylinder, I suspended the amniotic
membrane in the wound to act as a
filler and reduce the tension required for suturing," said Dr. Pettey.
The patient was happy with the
outcome and had a surprisingly
good uncorrected visual acuity. EW
Editors' note: The physicians have no
financial interests related to this article.
Contact information
Bordewick: eyestuff3@new.rr.com,
dbordewick@baycare.net
Kim: 408-851-4012,
evasterbunny@gmail.com
Pettey: 801-581-2352,
jeff.pettey@hsc.utah.edu
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