FEB 2014

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

Issue link: https://digital.eyeworld.org/i/274531

Contents of this Issue


Page 102 of 114

E W MEETING REPORTER 100 ously on four similar cases in 2001, "where [the anterior chamber] was so shallow that rather than using a n eedle [to aspirate vitreous and thereby deepen the anterior cham- ber], which was how I was trained as a resident, putting in the vitrector without infusion." "This time, you are not aiming for the lens, you are aiming for the optic nerve, because it is possible to hit the lens, the lens is very large in t hese cases," he said. "You're aiming for the posterior pole. It's firm, and you put in your vitrector, and one of the important things you have to do is palpate because you don't want to oversoften the globe." He said the surgeon does not have to go in very far with the vit- rector and then "all of the sudden, y ou have a deep chamber. You still have all the other problems, but it creates a lot of space." For pearls in these situations, physicians should be aware that these kinds of cases—small eyes, shallow anterior chamber, rock hard nucleus—are at risk for corneal wound burns, Dr. Yoo said. "Before you start phaco, espe- cially initially, where you're going to have total occlusion of the tip, irri- gate out a little path in your vis- coelastic to allow some fluid flow," she said. "The other thing is don't have a wound that is too tight." Uday Devgan, MD, Los Ange- les, said another pearl is that a large capsulorhexis is important in these situations. "Even if it's not going to overlap the optic, I want a big, generous rhexis [for] easier access to the c ataract," he said. Editors' note: The physicians have no financial interests related to this presentation. N ew methods could enhance toric alignment Multiple ways of marking the cornea f or correct toric IOL alignment exist, but some have the potential for accuracy issues, so an improved method could be useful. "There has to be a better way and that's the computerized, image- guided … aberrometry," said Dr. Devgan. At the "Mini symposium on a stigmatism correction," physicians discussed new technology for toric alignment and intraoperative aberrometry. Dr. Devgan gave an overview on current commonly used marking methods, including "the trusty marking pen, but that's a blob of ink that can bleed." The new methods discussed were the iTrace (Tracey Technolo- gies, Houston), which Dr. Yoo gave a brief overview on; TrueGuide (True- Vision, Santa Barbara, Calif.), which Mark Packer, MD, Portland, reviewed; Verion (Alcon, Fort Worth, Texas), which Terry Kim, MD, Durham, N.C., discussed; and the Callisto (Carl Zeiss Meditec, Jena, Germany), which Roger F. Steinert, MD, Irvine, Calif., highlighted. "There will be no more ink marking [with the Callisto], and as you've heard from some of the other s ystems, we're moving toward get- ting more precise registration so that we can get down to a very high de- gree of accuracy," Dr. Steinert said. Editors' note: Dr. Kim has financial interests with Alcon. The other physicians have no financial interests related to this presentation. Overcoming challenges in refractive surgery complications Case presentations demonstrated the difficult situations that can be en- countered in some refractive cases at the "Refractive surgery complica- tions: You make the call" session. These cases often have patients w ho had laser surgery when they were younger and, as they age, experience new ocular issues. "A lot of these [cases with] inter- ventions that we do over the course of time will develop cataracts, so you have to be ready to take care of them," said Karl G. Stonecipher, MD, Raleigh, N.C. Moderated by Dr. Yoo, the ses- sion featured examples of various complications. Dr. Stonecipher presented a case of a woman who underwent early refractive surgery with him in 1996 and has returned throughout the years with further is- sues, including undergoing an Intacs implant (Addition Technology, Des Plaines, Ill.). "Then she comes back in 2010 and her vision has dropped again … at this point, I have to start talking to her about cataract surgery," he said. He used the femtosecond laser to perform the cataract surgery. "The biggest point with all of these patients is that you may have to change the energy on the fem- tosecond laser, especially if you have RK incisions or other things," he said. He said he uses what is called the "spider web" pattern, "six chops, eight cylinders." Editors' note: Dr. Stonecipher has no financial interests related to this presentation. F ebruary 2014 Reporting live from the 2014 Hawaiian Eye, Kauai, Hawaii Sponsored by View it now ... EWrePlay.org Sonia H. Yoo, MD, discusses devices to aid in toric IOL orientation. Tuesday on EWrePlay 98-105 MR Hawaii_EW February 2014-DL2_Layout 1 1/30/14 11:57 AM Page 100

Articles in this issue

Links on this page

Archives of this issue

view archives of Eyeworld - FEB 2014