Eyeworld

EW NEWS & OPINION 17 preservatives can cause toxicity in the eye, putting patients at risk for toxic anterior segment syndrome (TASS), an acute inflammation of the anterior segment. Although most TASS cases are cured with topical steroids, severe cases can lead to cornea transplantation and iris atro- phy. "We ran out of non-preserved, bisulfate-free epinephrine in our university," said Nick Mamalis, M.D., professor of ophthalmology, John A. Moran Eye Center, Univer- sity of Utah, Salt Lake City. "The good news is if you have epineph- rine with bisulfates in it, it's proba- bly still safe to use if you dilute it properly." Should a shortage happen again, Dr. Mamalis suggested diluting the epinephrine, which comes in a glass vile in a strength of 1:1000, by 1:4 with BSS prior to mixing it with the lidocaine. "Instead of taking the epineph- rine right out of the glass vile and mixing it with the Shugarcaine, you want to take the extra step and di- lute it further," he explained. "We've been using it at our center in the last 2 weeks because we couldn't get bisulfate-free, and to be honest, I haven't noticed a difference. But we need to look into this further." At press time, Dr. Mamalis had not had a case of TASS by using the modified epi-Shugarcaine. Dr. Masket's strategy was to limit the use of non-preserved, bisul- fate-free epinephrine to patients who have a history of using Flomax (tamsulosin, Boehringer Ingelheim Pharmaceuticals, Ridgefield, Conn.). He and his colleagues at the surgery center clambered to find additional suppliers of the product, but had yet to find any at press time. They are also exploring the use of intracameral phenylephrine 1.5% preservative-free, a method com- monly used in Europe and Canada. Although phenylephrine is not available in the U.S., surgeons can purchase the product from Canada or Europe. "We're going to try it out and see how it works. If it works, it will be the replacement for epineph- rine," said Carlos Bravo, the lead technician in Dr. Masket's office. "I hope it works, because if not, we're going to go back to the age of sur- gery where we used iris hooks or a Malyugin Ring. But those items are extremely expensive. It will hike up the cost of the surgery." EW Editors' note: Drs. Mamalis and Masket and Mr. Bravo and Mr. Tozi have no financial interests related to their com- ments. Contact information Bravo: cbravo@symbion.com Mamalis: nick.mamalis@hsc.utah.edu Masket: sammasket@aol.com Tozzi: wtozzi@americanregent.com August 2011 D.O.R.C. International B.V. Scheijdelveweg 2 3214 VN Zuidland The Netherlands Phone: +31 181 45 80 80 Fax: +31 181 45 80 90 E-mail: sales@dorc.nl Dutch Ophthalmic USA 10 Continental Drive Bldg 1, Exeter, NH 03833, U.S.A. Phone: +1 800-75-DUTCH or +1 603-778-6929 Fax: +1 603-778-0911 E-mail: sales@dutch ophthalmicusa.com MEMBRANEBLUE TM 0.15% Trypan Blue Ophthalmic Solution INDICATIONS FOR USE MembraneBlue ™ is indicated for use as an aid in ophthalmic surgery by staining the epiretinal membranes during ophthalmic surgical vitrectomy procedures, facilitating removal of the tissue and reducing the risk of retinal damage. Staining also reduces the chance of incomplete peeling of the membrane, which could lead to persisting metamorphopsia. The application of MembraneBlue ™ onto the ILM or the ERM resulted in a useful bluish staining, facilitating the identification, delineation, and removal of the membranes in all surgeries. No residual staining or adverse effects related to MembraneBlue ™ were observed. 1 MembraneBlue ™ staining of the internal limiting membrane, epiretinal membranes, and the posterior hyaloid is a useful adjunct in vitreoretinal surgery and improves the efficiency and safety of membrane identification and removal. 2 SPECIAL CONSIDERATIONS It is recommended that after injection all excess MembraneBlue ™ is immediately removed from the posterior chamber of the eye. MembraneBlue ™ is contraindicated when a non-hydrated, hydrophilic acrylic lens is planned to be inserted into the eye. Adverse reactions reported following use of MembraneBlue ™ include discoloration of high water content hydrogen IOLs and inadvertent staining of the posterior lens and vitreous face, which is generally self-limited, lasting up to one week. NOW AVAILABLE TO US SURGEONS Please see adjacent page for brief prescribing information. 1. Teba FA, Mohr A, Eckardt C, Wong D, Kusaka S, Joondeph BC, Feron EJ, Stalmans P, Van Overdam K, Melles GRJ. Trypan blue staining in vitreoretinal surgery. Ophthalmology 2003; 110(12):2409-12. 2. Vote BJ, Russell MK, Joondeph BC, Trypan Blue-Assisted Vitrectomy, Retina 2004; 24(5):736-8. D.O.R.C. International B.V. Scheijdelveweg 2 3214 VN Zuidland The Netherlands Phone: +31 181 45 80 80 Fax: +31 181 45 80 90 E-mail: sales@dorc.nl Dutch Ophthalmic USA 10 Continental Drive Bldg 1, Exeter, NH 03833, U.S.A. Phone: +1 800-75-DUTCH or +1 603-778-6929 Fax: +1 603-778-0911 E-mail: sales@dutch ophthalmicusa.com ERGONOMICALLY DESIGNED, PRECISION ENGINEERED TO GIVE YOU AN ADVANTAGE. See what other advantages D.O.R.C. can offer you! INNOVATION WITH AN ADVANTAGE... THE D.O.R.C. ADVANTAGE Until now, disposable microforceps and scissors have fallen short of achieving the same level of action and performance as reusable instruments. The Dutch Ophthalmic Research Center, the first to develop disposable instruments, now offers you a distinct advantage in disposable instrumentation. The D.O.R.C. Advantage line has been clinically engineered to overcome the functional limitations of existing disposable instruments while delivering maximum performance and functionality. placed in the sulcus with the optic captured via the buttonhole tech- nique through the capsulorhexis. This provides excellent stability of the lens and creates a barrier to pre- vent vitreous prolapse. The post-op course for these pa- tients tends to be straightforward, particularly if the posterior capsule remains intact. After contraction of the capsular bag has created a strong fixation for the IOL, a YAG laser cap- sulotomy can be performed for any residual posterior capsule opacity. Using viscodissection, posterior polar cataracts can be effectively treated while minimizing the risks. EW References 1. Addison PK, Berry V, Ionides AC, Francis PJ, Bhat- tacharya SS, Moore AT. Posterior polar cataract is the predominant consequence of a recurrent muta- tion in the PITX3 gene. Br J Ophthalmol. 2005 Feb;89(2):138-41. 2. Osher RH, Yu BC, Koch DD. Posterior polar cataracts: a predisposition to intraoperative poste- rior capsular rupture. J Cataract Refract Surg. 1990;16:157–62. 3. Vasavada A, Singh R. Phacoemulsification in eyes with posterior polar cataract. J Cataract Refract Surg. 1999;25:238–45. 4. Lee MW, Lee YC. Phacoemulsification of posterior polar cataracts—a surgical challenge. Br J Ophthal- mol. 2003 Nov; 87(11): 1426–1427. 5. Kumar S, Ram J, Sukhija J, Severia S. Pha- coemulsification in posterior polar cataract: does size of lens opacity affect surgical outcome? Clin Experiment Ophthalmol. 2010 Dec;38(9):857-61. 6. Fine IH, Packer M, Hoffman RS. Management of posterior polar cataract. J Cataract Refract Surg. 2003 Jan;29(1):16-9. 7. Devgan U. Visco-Dissection Technique for Poste- rior Polar Cataracts. Grand Prize winner, Asia-Pacific Academy of Ophthalmology Meeting 2005, Kuala Lumpur, Malaysia. Editors' note: Dr. Devgan has no finan- cial interests related to this article. Contact information Devgan: 800-337-1969, www.devganeye.com Obtaining continued from page 14 02-17 News Update_EW August 2011-FINAL_Layout 1 7/27/11 3:34 PM Page 17

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