AUG 2013

EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.

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The use of viscoelastic to aid in the stretching of the pupil and maintain stability in the chamber will work as long as the surgery is quick and efficient. Phaco power must be applied in a controlled fashion and the fluidics must cause minimal turbulence inside the eye or a number of complications may arise including: loss of pupillary diameter necessitating use of a Malyugin ring, loss of the function of the bleb, or breakage of the capsule due to poor visualization. I use the WhiteStar Signature System (AMO) with peristaltic fluidics because the phaco is very powerful while at the same time controlled. The fluidics on this machine are impressive, enabling a focused and effective removal of the lens that can comfortably be completed with a compromised eye. I use a Dewey Radius Phaco Tip (Innova Medical, Toronto), which helps me control the entire process. After the cataract was removed, I scanned the eye using the ORA intraoperative aberrometer (WaveTec Vision, Aliso Viejo, Calif.) to measure the net astigmatism power and visual axis. These new measurements allowed me to select the correct toric lens, which was different from what the preoperative measurements indicated should be used. Once the lens was implanted, I used the ORA system again to confirm the axis and power. Follow-up care for this patient was routine, with exams at one day, one week, and one month. By the day after surgery, the patient achieved 20/20 vision and his IOP was in the mid-teens, slightly lower than preoperatively. Surgeons understand that great outcomes are possible in very complicated cases, but there is no margin for error. Good results from a toric IOL already require great precision, and a small pupil and pre-existing filtering bleb add further complexity. If the viscoelastic is unable to perform as needed or choppy fluidics create too much trauma, a surgical plan may have to be modified and the use of a toric lens abandoned. Confidence and comfort with my tools and equipment are paramount for me prior to beginning any complicated surgery. EW Reference 1 Ramulu PY, Corcoran KJ, Corcoran SL, Robin AL. Utilization of various glaucoma surgeries and procedures in Medicare beneficiaries from 1995 to 2004. Ophthalmology. 2007;114(12):2265-2270. EditorsÕ note: Dr. Waltz is a partner with Eye Surgeons of Indiana. He has financial interests with AMO. Contact information Waltz: kwaltz56@gmail.com Save The Date! Sponsored by the Cornea Society APRIL 15-17, 2015 SAN DIEGO 2015 www.corneacongress.org

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