MAR 2014

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

Issue link: https://digital.eyeworld.org/i/276058

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Page 171 of 210

E W MEETING REPORTER 1 69 cataract surgery. However, when im- planting the three-piece hydropho- bic IOL, the lens had been folded in reverse—a first for Dr. Chakrabarti— so that the IOL was flipped antero- posteriorly. Yet it wasn't until four weeks postop that the patient re- turned complaining of monocular diplopia with dysphotopsias. The IOL was grossly displaced superotemporally. The posterior cap- sule had ruptured. Dr. Chakrabarti decided to reposition the lens. His technique was simple: Injecting copious amounts of dispersive OVD below the cornea to protect the endothelium and above the posterior capsule to pre- vent the IOL from dropping into the vitreous, he moved the IOL into the anterior chamber, flipped the lens, and implanted it in the sulcus. For flipping the lens, Dr. Chakrabarti cautioned that the surgeon should ensure adequate OVD; otherwise, the procedure is as simple as it sounds; sometimes you just don't need to overthink things, he said. Cyres K. Mehta, MD, Mumbai, treated a case of ectopia lentis with what he called the Bag-to-the-Wall technique. The surgeon should begin with a small, centered rhexis since there is a tendency for the tear to extend. In these cases, he cau- tioned, a laser might not be useful since it could position the rhexis under the iris, and for the technique the rhexis needs to be properly centered and fully exposed. The bag is then pulled up by the rhexis edge with iris hooks; the sur- geon should be wary of letting the edge slip since the rhexis will tend to curl up on itself. The cataract is removed using a chop technique, and the remaining cortex removed using 200 to 300 mm Hg of vacuum. A capsular tension ring is then inserted for support and to restore the shape of the bag. A prolene suture is inserted through the leading haptic of a one- piece IOL; using a straight needle, the suture is inserted into the ante- rior chamber and passed through the fornix. The suture is pulled through as the lens is inserted and the leading haptic pushes the capsu- lar bag against the wall—hence the name—and the suture is locked by passing the needle twice through the conjunctiva. Meanwhile, in a case with an opaque cornea, Dr. Mehta demon- strated how the use of a light pipe inserted into the anterior chamber can allow the surgeon to perform cataract surgery without first per- forming keratoplasty. The different possibilities for treating subluxated cataracts— among the most common of phaco complications—represent the state of cataract surgery in the face of complications today. Chitra Ramamurthy, MD, Bangalore, described the many different approaches she uses to address the problem. Among them are the use of capsule hooks to provide traction as well as good visibility in cases with poor capsular support, and the em- ployment of other devices such as the Cionni ring and iris clip lenses. These different strategies, provided for by the many available devices for cataract surgery, she said, mean that surgeons can address subluxated lenses—and, indeed, virtually any phaco complication— during either the primary or second- ary surgery. EW March 2014 164-169 MR AIOC_EW March 2014-DL2_Layout 1 3/6/14 4:30 PM Page 169

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