Eyeworld

EW FEATURE 48 you go around 360 degrees using viscoelastic and blunt dissection with your viscoelastic cannula to open it up." One trick to help ensure that the lens doesn't stick as easily is to polish the undersurface of the cap- sule when doing the initial implan- tation, Dr. Hoffman said. He credits Richard Mackool, MD, with the idea. "If you polish all lens epithelial cells off and put a premium lens in the eye, theoretically it's easier to get the bag reopened six months after the surgery," Dr. Hoffman said. During the explantation process, there is also the possibility of the whole bag coming out. There could be zonular dialysis with vitre- ous loss resulting in the bag coming loose and having to be explanted. It then becomes necessary to sew the lens either to the sclera, the iris or to put an anterior chamber lens in the eye. In cases where the new lens can- not be placed in the bag or sulcus, Dr. Hoffman sees a variety of alter- natives. "If there's some support and they have most of their vitreous, I think the simplest thing is iris fixa- tion," he said. However, if the pa- tient has had a complete vitrectomy, there may be too much movement of the iris and the lens, and this can result in a recurrent hyphema. Dr. Hoffman views an anterior chamber lens as a viable option for some. "The older the patient, the more likely he or she will be fine with an anterior chamber lens," he said. For those who have undergone a vitrec- tomy, Dr. Hoffman suggests scleral fixation of a posterior chamber lens, use of an anterior chamber lens, or gluing a posterior lens in the poste- rior chamber with intrascleral haptic capture. Dr. Park's preference in such cases is to use a three-piece iris-fix- ated lens, sutured in place. However, she also views well-positioned ante- rior chamber lenses these days as a good alternative. Overall, Dr. Park cited problems with the refractive power of the lens as the most common reason for ex- planting an IOL. She pointed out, however, that many machines avail- able for making the calculations are very good. "I think that's going to decrease the incidence of having to exchange lenses," she said. Still, with many prior refractive surgery patients now coming in for cataract surgery, she acknowledged that given the difficulty of getting the power right, this will remain a pro- cedure at the forefront. "This is defi- nitely an issue that every cataract surgeon needs to be comfortable with," Dr. Park said. EW Editors' note: Dr. Hoffman has financial interests with MicroSurgical Technology and Carl Zeiss Meditec (Jena, Germany). Dr. Park has no financial interests related to her comments. Contact information Hoffman: rshoffman@finemd.com Park: Lisa.park@nyumc.org February 2011 Pseudophakic dysphotopsia April 2014 Gone continued from page 46

• Cover