EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
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Reporting live from the 2014 ASCRS•ASOA Winter Update Fajardo, Puerto Rico E W MEETING REPORTER 154 elevation," he said, but this is the only real con. The positives far outweigh the negatives, and the p ositive points include precision (especially with capsulotomy), use with loose zonules, astigmatism management, and greater safety. The postoperative IOP management of a cataract patient on glaucoma med- ication depends on the extent of glaucoma damage, diagnosis and other systemic problems. Dr. Lewis' l ast pearl involved microinvasive glaucoma surgery, or MIGS, which he said is here to stay, so it's impor- tant to get comfortable with the technology and applications. "There's definitely a learning curve," he said. Dr. Bakewell spoke on the white, mature lens. "The first thing is, you w ant to use capsular dye," he said. Other pearls are to minimize the posterior pressure, use appropriate OVD, and decompress both the anterior and posterior cortical spaces. Finally, "keep the capsu- lorhexis small in case the posterior cortical space still has increased pressure," he said, suggesting that the capsulorhexis should be about 3 to 4 millimeters. His bonus pearl was that the femto rhexis may be the ultimate solution. Dr. Steinert addressed astigma- tism in cataract patients. His first pearl was to always do preoperative corneal topography. He also said not to be fooled by refraction and that lenticular astigmatism is real. He suggested using Koch's rule for posterior corneal astigmatism correction, but added that there is no current technology that reliably measures posterior corneal astigma- tism. "At least consider intraopera- tive aberrometry," Dr. Steinert said for his fourth pearl. As his last point, he said to wait to address the problem if the toric IOL is malpositioned postoperatively. Editors' note: Drs. de Luise, Bakewell and Steinert have no financial interests related to his presentation. Dr. Lewis has financial interests with Aerie, Alcon, Allergan, AqueSys, Glaukos, and Ivantis. Cornea case management The "Cornea Case Management" session was an interactive workshop l ed by Dr. Rubenstein, Dr. de Luise, and W. Barry Lee, MD, Atlanta. One topic that was discussed was DMEK, which Dr. Rubenstein said is slowing gaining momentum to become ac- cepted in the ophthalmic commu- nity. He highlighted some important points in the advantages of DMEK. He said that eye banks are preparing t he tissue ahead of time, meaning that there's no need for surgeons to dissect the Descemet's membrane themselves. He also said there is a better delivery system now, a modified Jones Tube developed by Michael Straiko, MD, Portland, Ore. Dr. Rubenstein said that he uses SF6 gas in DMEK. Editors' note: Dr. Rubenstein has no financial interests related to his presentation. Glaucoma tips and tricks In a session called "Updating your glaucoma treatment armamentar- ium," a panel of experts provided pearls for treatment of the disease. Dr. Lewis uses gonioscopy and opti- cal coherence tomography (OCT) to diagnose narrow angles. "The advent of OCT has really helped," he said. "It's doesn't take a specialist to do this. You can image the angle and make treatment plans based on your OCT. And it's reimbursable. There's no reason not to do it." "Spectral domain OCT has pro- vided definitive information about the angle that we never could appre- c iate before," Dr. Lewis said. It's especially helpful in explaining to patients why they need a laser irido- tomy. A YAG peripheral iridotomy helps prevent angle closure in high-risk patients. "Lens removal is necessary in high hyperopia and lens-induced glaucomas," Dr. Lewis said. It is contraindicated when a g rowing angle melanoma causes the angle closure or when a lens is sub- luxed. Dr. Lewis told attendees to consider a retrobulbar block in pa- tients who have severe pain from angle-closure glaucoma. The block immediately and "impressively" calms a patient and prepares them for further treatment, Dr. Lewis ad- v ised. "It's the most dramatic thing I have seen in angle-closure glau- coma," he said. "It doesn't lower the pressure, but it alleviates the nausea and vomiting." In his talk, Dr. Samuelson of- fered "Five Glaucoma Management Pearls for 2014." First, he advised surgeons to select and master a microinvasive glaucoma surgery (MIGS). "You want to have one of these technologies to offer your pa- tient population." Dr. Samuelson said some definitions of MIGS procedures require an ab interno approach. He prefers canal-based stenting surgeries. "My bias for canal-based procedures is that the safety has been proven," he said. Second, Dr. Samuelson said practi- March 2014 Sponsored by View it now ... EWrePlay.org Vincent P. de Luise, MD, discusses ocular surface disease and phacoemulsification. 149-159 MR WU2014_EW March 2014-DL2_Layout 1 3/6/14 4:21 PM Page 154