Eyeworld

JULY 2023 | EYEWORLD | 29 Contact Chang: dchang@empireeyeandlaser.com Mah: Mah.Francis@scrippshealth.org McCabe: cmccabe13@hotmail.com Moster: marlenemoster@gmail.com 8. Hold the suture while indenting into the sclera slightly when at the proper tension. 9. Cut the suture 1–1.5 mm from the surface to make a small flange. 10. Bury the flange into superficial layers of the sclera. She also emphasized the need to have a special place in the OR to keep instruments for complex cases, review videos with staff, and film and review your own surgeries to refine techniques. For the cornea presentation, Francis Mah, MD, presented on behalf of Terry Kim, MD, on the topic of ocular surface and cataract surgery. Everyone realizes dry eye is one of the most common ocular conditions that can result in sig- nificant symptoms of discomfort and vision loss, Dr. Mah said. The tear film is the first refractive interface. Tear film irregularities preop and postop can affect and degrade retinal image quality by 20–40% and can cause problems with visual acuity and higher order aberrations, he said. Dry eye is one of the most common causes of dissatisfaction in surgical patients, Dr. Mah said, and can cause discomfort, visual fluctu- ations, and increased difficulty with computer use or night driving. There are many dry eye diagnostics avail- able, and Dr. Mah said treatment has come a there was nothing to provide countertraction as she was proceeding with capsulotomy. She had iris hooks on hand, which she said are a little more versatile than capsular hooks. You want to think about where the forces are during the capsulotomy and provide countertraction to the force that's being put on the edge of the capsu- lorhexis, Dr. McCabe said. Dr. McCabe described how she used polypropylene suturing in this case, carefully considering the path of the suture when creat- ing a loop through the capsular tension eyelet and anchoring it to the scleral wall. With this technique, she externalized a 30-gauge needle through a paracentesis after passing it through conjunctiva and sclera and into the sulcus. A cut segment of 6-0 polypropylene suture was threaded into the needle lumen, externalized by withdrawing the needle, then treated with low temperature cautery to create a flange. A second needle was passed and the other end of the same piece of suture was externalized to create a belt loop supporting a capsular tension segment that fixated the capsule to the sclera. She performed a limited anterior vitrectomy through the pars plana, implanted an IOL, then slowly adjusted the tension on the sutures by externalizing the sutures to elevate the IOL. "If you're doing any other polypropylene and belt loops procedures, the slow externalization of sutures is important to position the lens in a planar fashion behind the iris," she said. Dr. McCabe offered pearls for polypropylene flanged techniques: 1. Cut the suture segment at a bevel. 2. Test the suture by passing into the needle outside the eye. 3. Make a long tunnel when passing the needle through the sclera. 4. Feed the suture into the needle, inside the eye with microforceps, by preplacing into the lumen of the needle and extruding or by externalizing the needle through a paracentesis. 5. Push the suture into the eye as you withdraw the needle. 6. Make a large "safety" flange initially. 7. Slowly externalize more suture to adjust the tension. Relevant disclosures Chang: Johnson & Johnson Vision Mah: Alcon, Aldeyra, Allergan, Aperta Biosciences, Azura, Bausch + Lomb, Kiora, Novartis, NuLids, Oyster Point, Sight Sciences, Sun Pharma, Tarsus Pharmaceuticals McCabe: None Moster: None continued on page 30 Dr. Moster delivers the Lindstrom Lecture, discussing problems in glaucoma and potential new innovations to address them. Source: ASCRS

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