SEP 2013

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

Issue link: https://digital.eyeworld.org/i/176967

Contents of this Issue


Page 74 of 98

72 EW International September 2013 International outlook Amputated haptics: The good and the bad by Matt Young EyeWorld Contributing Writer T here is no such thing as a surgeon who never has a complication. The hallmark of great surgeons, however, is not that they are perfect but rather how they handle difficult situations. Presented here are two more options to consider should you find yourself with a difficult IOL delivery. It's always a judgment call on what to do. I can still hear the words of my senior resident as he mentored me on my first cataract surgery: "Trust your instincts and keep your patient's best interest in mind." This has proven to be sound advice that has served me well throughout my career. John A. Vukich, MD, international editor O ftentimes, amputated haptics are obviously a bad thing. But they don't have to derail a good cataract procedure. Subhash Prasad, MD, chief consultant and founder, Divyadrishti Eye Centre, India, recently described a new approach to rescue stuck haptics trapped in the cartridge. In rare cases, amputating the haptics may be helpful, as described by Marcelo Ventura, MD, chief of the Department of Cataract and Retina and Vitreous, Hospital de Olhos de Pernambuco, and Altino Ventura Foundation, Brazil, who implanted an endocapsular tension ring and amputated one loop haptic in order to align the IOL's optic with the patient's visual axis in a case of congenital lens subluxation. Amputated haptics can be a fact of ophthalmic life—bad or good— that surgeons should come to terms with. These international surgeons suggest helpful ways to do just that. Avoiding explantation In case after case, Dr. Prasad realized he was having a problem. "The implantation of an IOL most of the time is a very trivial affair," Dr. Prasad said in a video he recently produced, which was showcased at the 2013 APACRS Film Festival in Singapore. "Accidents can happen sometimes. There can be scratch marks on the optics, breaking of the visual optics, and in some cases, amputation of haptics from the optics." It was this final problem—amputated haptics—that began to get on Dr. Prasad's nerves. "It was just another day in the OR going in a very planned and predictable way when I suddenly met an accident," Dr. Prasad said. "My joy of accomplishing yet another case culminated suddenly in frustration. When I was pushing the plunger, I felt some resistance." Dr. Prasad's single-piece hydrophilic acrylic foldable lens with C-loop design was delivered into the eye with one haptic broken and trapped in the cartridge. An endocapsular tension ring and partial amputated loop was used in order to align the IOL's optic with the patient's visual axis. Source: Marcelo Ventura, MD "I had no choice but to take [the lens] out," Dr. Prasad said. The lens was cut into pieces under cover of an OVD, and surgery was subsequently completed by implanting another foldable lens. This was not ideal, however, since the situation leads to a loss of an IOL, money, time, and quite possibly an injured endothelium. "Despite taking meticulous precaution while loading the lens, on another day, the same situation was waiting for me again," Dr. Prasad said. "The leading haptic and optic of a C-loop designed IOL delivered almost the way I expected," he said. "But the trailing haptic got stuck between the wall of the cartridge and the plunger. The haptic would not be released." But then a lightbulb went on inside Dr. Prasad's head. "I tried something new," he said. "I decided to cut the wall of the cartridge with a knife, taking precautions not to injure the haptic. I made an incision in the cartridge, taking all the precautions. As soon as it was cut, the trailing haptic was released. The IOL dialed in the bag without any damage." Cutting the cartridge may not be possible in all situations. The cartridge is very thick in some cases, so this procedure may not work, he said. "One can take a chance and try," Dr. Prasad said in a subsequent interview. "This cartridge was more pliable. With one or two incisions, it was cut. At the same time, one has to pay attention to the anterior chamber, using good quality viscoelastic to coat the cornea." Dr. Prasad said he shared his technique with colleagues experiencing the same problem, and they were helped by it. "Even an experienced surgeon can become complacent loading and implanting the IOL," Dr. Prasad said. "We often start out doing a good capsulorhexis and phacoemulsification, but this can happen to any surgeon." Correcting subluxation Meanwhile, amputating haptics in some cases is just what the doctor planned.

Articles in this issue

Archives of this issue

view archives of Eyeworld - SEP 2013