Eyeworld

EW CATARACT/IOL 51 might think if you had a lot of over- weight patients that perhaps they have a higher level of type 2 dia- betes, but that wasn't the case," Dr. Hugkulstone said. He theorized that medications taken by these patients may be at the root here. "Those with breathing problems may be on ei- ther systemic or inhaled steroids, which may contribute to the devel- opment of cataracts," he said. Keys to success For those who want to undertake a standing case, first and foremost, Dr. Hugkulstone recommended making sure that you're up to the challenge. "Make sure that you're reasonably experienced at doing phacoemulsifi- cation," he said. He also recommended that in such cases practitioners use a low- zoom microscope since there is less ability to operate the microscope if you are phacoing at the same time. "Otherwise both feet are off the floor, which is a recipe for disaster for the surgeon," Dr. Hugkulstone said. However, he finds that a lower- zoom microscope allows the practi- tioner to accommodate a bit and cope with differences in the position of the eye since some of these pa- tients can have their heads fully ex- tended. One final recommendation, sug- gested by a colleague, is to use con- tinuous irrigation while phacoing. While Dr. Hugkulstone did not use this approach in the study, he sees this as helpful. "I think that contin- uous irrigation is good because it means that you can leave the phaco probe in the eye while you readjust the microscope," he said. Overall, Dr. Hugkulstone hopes that practitioners come away from the study with the knowledge that the standing approach is safe. "The take-home message is that it can be done with these difficult patients," he said. "However, don't do it if you're not terribly experienced with phacoemulsification—have the courage to suggest a colleague who is more experienced." This aside, he sees the standing approach as a very viable one. "Once you feel comfort- able with your surgical skill, there is really no reason why you shouldn't do the procedure yourself," Dr. Hugkulstone said. "It appears these patients do as well as those who are able to lay flat." EW Editors' note: Dr. Hugkulstone teaches basic and intermediate phacoemulsifi- cation in an unpaid capacity for Alcon (Fort Worth, Texas). Contact information Hugkulstone: charles.hugkulstone@nhs.net Save the Date February 2011

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