EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
Issue link: https://digital.eyeworld.org/i/146899
A S C R S World view Passing along hard-earned knowledge "Maturity is about challenging yourself and improving! And then taking that experience to help others ... " –Tsem Tulku Rinpoche C ataract surgery can be straightforward or very complex. From small pupils to dense lenses, most surgeons will encounter difficult cases on a daily basis. Managing these situations takes a comBonnie An Henderson, MD, bination of knowledge, skill, and the proper tools. cataract editor In this issue, mechanical and chemical management of poor pupillary dilation is discussed. Boris Malyugin, MD, describes the recent modifications of his Malyugin ring for cases with small pupils. Some surgeons, such as Ramon Lorente, MD, and Victoria de Rojas, MD, have successfully used intracameral phenylephrine to manage small pupils associated with intraoperative floppy iris syndrome. They found that intracameral injection of the phenylephrine also reversed the floppy behavior of the iris and dilated the pupil to the preoperative size. The femtosecond laser was previously believed to be useless in the setting of small pupils, but William Culbertson, MD, describes a different approach in which the femtosecond laser is used to create a perfectly centered and round capsule opening after implanting the Malyugin ring. For dense cataracts, Dianna Bordewick, MD, and Jeff Pettey, MD, have a backup plan. While they usually rely on phacoemulsification for most cataract extractions, they find that reverting to a manual small incision cataract surgery can be the best approach for very dense lenses. If attempting phacoemulsification, utilizing tools such as trypan blue stain and the Ultrachopper (Alcon, Fort Worth, Texas) can improve visualization and increase efficiency. Eva Kim, MD, shares other tips such as a larger capsule opening and altering the fluidics to optimize the delivery of energy. The postoperative management of cataract surgery can become more complex in the setting of co-existing macular disease. Netan Choudhry, MD, Kevin Miller, MD, and Kenneth Rosenthal, MD, discuss their approaches to patients with macular disease and cataracts. The importance of preoperative, perioperative, and postoperative administration of topical NSAIDs is described. While the individual approaches may be different, the use of NSAIDS for patients in high-risk categories is generally accepted by all. The implantation of multifocal IOLs in patients with co-existing macular disease is controversial. The doctors discuss the potential disadvantages of multifocal IOLs for these patients. Encountering a post-refractive surgery patient with visually significant cataracts is becoming more and more common. This situation still remains one of the most feared cases for cataract surgeons due to the inaccuracy of the IOL power calculations. With the advances in IOL formulas and the advent of intraoperative aberrometry, the outcomes continue to improve. However, for those patients who have a history of radial keratotomy, the accuracy and stability remain an issue. Barry Schechter, MD, Barbara Bowers, MD, Uday Devgan, MD, and Sam Masket, MD, describe their approach to this complex problem. Managing complicated cases is truly an art rather than a science. Being prepared, having the right tools, and gaining the skills through experience seems to be the right approach. As the Tibetan Buddhist Tsem Tulku Rinpoche stated above, by tackling the challenging cases, cataract surgeons are maturing and hopefully passing along their hard-earned knowledge to others after them. Bonnie An Henderson, MD, cataract editor The official publication of the American Society of Cataract & Refractive Surgery July 2013 Volume 18 • No. 7 P U B L I S H I N G S TA F F Publisher Matt Young don@eyeworld.org Enette Ngoei Donald R. Long Editorial Editor Jena Passut jena@eyeworld.org Managing Editor Stacy Majewicz stacy@eyeworld.org Senior Staff Writer Erin Boyle erin@eyeworld.org Malaysia Dublin Rich Daly Arlington, Virginia Senior Contributing Writer Maxine Lipner Nyack, New York Advertising Sales ASCRSMedia 4000 Legato Road Suite 700 Fairfax, VA 22033 ellen@eyeworld.org 703-591-2220 fax: 703-591-0614 eyeworld@eyeworld.org www.eyeworld.org Production Advertising Sales Graphic Designer Jeff Brownstein Julio Guerrero jeff@eyeworld.org julio@eyeworld.org 703-788-5745 Production Manager Paul Zelin Staff Writer Ellen Stodola Cathy Stern cathy@eyeworld.org 703-383-5702 Production Assistant Daniela Galeano daniela@eyeworld.org Contributing Writers Vanessa Caceres Lakeland, Florida Michelle Dalton Reading, Pennsylvania paul@eyeworld.org 703-383-5729 Classified Sales Cathy Stern cathy@eyeworld.org 703-383-5702 EyeWorld Special Projects and Events Jessica Donohoe jessica@eyeworld.org 703-591-2220 ASCRS Publisher: EYEWORLD (ISSN 1089-0084) is published monthly by ASCRS Ophthalmic Services Corp., 4000 Legato Road, Suite 700, Fairfax, VA 22033-4055; telephone: 703-591-2220; fax: 703-591-0614. 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