JAN 2014

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

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January 2014 Phaco and vitrectomy capsular bag is floppy one can fill the capsular bag with a dispersive viscoelastic to push the bag posteriorly and allow for safe removal of the final lens fragments during phacoemulsification. Similarly, inflating the bag with a dispersive viscoelastic and performing a bimanual irrigation and aspiration approach during cortical cleanup can ease removal in the setting of a floppy bag. An alternative approach is to place a capsular tension ring to re-establish a taut capsule. When dealing with posterior capsule rent, Dr. Fram recommended attempting to make a generous capsulorhexis, around 5.5 to 6.0 mm, to help facilitate the removal of the lens. "The goal is to deliver the lens into the anterior chamber for nuclear disassembly and removal," she said. "Copious use of dispersive viscoelastic in front and behind the lens with gentle viscodissection is also useful in this scenario." and peripheral retinal pathology is warranted in all eyes undergoing cataract surgery after vitrectomy," Dr. Fram said. EW References 1. Wilbrandt HR, Wilbrandt TH. Pathogenesis and management of the lens-iris diaphragm retropulsion syndrome during phacoemulsification. J Cataract Refract Surg. 1994 Jan; 20(1):48-53. 2. Cionni RJ, Barros MG, Osher RH. Management of lens-iris diaphragm retropulsion syndrome during phacoemulsification. J Cataract Refract Surg. 2004 May;30(5):953-6. 3. Nahra D, Pazos-Lopez M, Castilla-Cespedes M. Iris hook as a management technique for lens-iris diaphragm retropulsion syndrome. J Cataract Refract Surg. 2007 Feb;33(2):177. 4. Miyake K, Asakura M, Kobayashi H. Effect of intraocular lens fixation on the blood-aqueous barrier. Am J Ophthalmol. 1984; 98:451-5. EW FEATURE 41 5. V M Ferguson and D J Spalton. Recovery of the blood-aqueous barrier after cataract surgery. Br J Ophthalmol. 1991 February; 75(2): 106–110. Editors' note: The physicians have no financial interests related to this article. Contact information Braga-Mele: rbragamele@rogers.com Fram: nicfram@yahoo.com Huang: Suber.Huang@UHhospitals.org What postop anti-inflammatory regimen do you use in nondiabetic, post-vitrectomy eyes? Dr. Huang said that inflammation can exacerbate most complications of ocular surgery, including proliferative vitreoretinopathy. "I typically use sub-Tenon's dexamethasone 10 mg and cefazolin 50 mg at the end of the case, tobramycin/dexamethasone ointment and homatropine 5% with patch and shield, and a combination drop/homatropine 5% QID," he said. "If inflammation is a particular concern, I add a nonsteroidal anti-inflammatory therapy." Dr. Braga-Mele said her postop routine for these eyes is no different from the treatment she would use in a standard cataract case, unless the case has presented difficulties. "If it's all gone well, then it's my standard routine of using a nonsteroidal antiinflammatory for a total of four to six weeks and a steroid as well," she said. Dr. Fram said that patients who have a history of pars plana vitrectomy may benefit from pre-treatment one week prior to surgery with a topical steroid and NSAID. "Preoperative topical NSAID use can potentially improve perioperative stability of pupillary dilation and address pre-existing retinal pathology such as subclinical macular edema," she said. "Typically, this can be continued for four to six weeks postoperatively." This postoperative regimen correlates with evidence that it could take up to six weeks or longer for the blood-aqueous barrier to recover.4,5 "Careful evaluation of the retina postoperatively for macular edema EXPLORATIONS IN CORNEA, CATARACT, PEDIATRICS, AND RETINA New Orleans Academy of Ophthalmology 63rd Annual Symposium March 21–23, 2014 Hilton Riverside Hotel New Orleans, LA PROGRAM HIGHLIGHTS: FACULTY: • • • • • • • • • • • • • • Riva Lee Asbell, AB, CO Audina Berrocal, MD Edward Buckley, MD Jeffery Daigrepont Terry Kim, MD J. Bradley Randleman, MD Uday Devgan, MD David B. Granet, MD Robert Osher, MD William Rich, MD M. Edward Wilson, MD Sonia H. Yoo, MD Anti-VEGF update Can't code this! New challenges for 2014 Cataract video symposium I and II – Led by Robert Osher Cornea edema after cataract surgery Health care policy – What you need to know now I wish I hadn't done that! – Lessons learned the hard way ICD 10, E.H.R., Practice management Managing the atypical cornea in cataract surgery Surgical time in femtosecond vs. conventional cataract surgery State of the art: Pediatric cataract surgery Strategies for LASIK retreatments Troubleshooting the unhappy premium IOL patients Update on collagen cross-linking What am I doing wrong here? Learning from tough cataract cases For more information, call 504-861-2550, email: meetings@noao.org. information, Online registration and hotel information available at www.noao.org. information www.noao.org. An outstanding independent provider of continuing medical education for over 60 years. The New Orleans Academy of Ophthalmology is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

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