Eyeworld

EW FEATURE 69 He uses either MMC 0.02% or MMC 0.04%, "but it's the location that differs. I apply it only in the border where the pterygium was re- moved. I don't apply it at all to bare sclera." Dr. Tseng's method of grading pterygium severity is based on Donald T.H. Tan, F.R.C.Ophth., et al.'s studies on the topic. In cases of mild pterygium (where episcleral blood vessels suggest the amount of fibrovascular tissue that is fully visi- ble in between the conjunctiva and Tenon), Dr. Tseng recommends ap- plying MMC for about 1-2 minutes at the fornix edge. For moderate pterygium (partially visible fibrovas- cular tissue), Dr. Tseng recommends 2-3 minutes of MMC. Severe ptery- gium (non-visible fibrovascular tis- sue) mandates 4-5 minutes of MMC, he said. He also recommends using a Q-tip to dry the bare sclera during incubation. Planned simultaneous surgery If Dr. Palmon is using MMC during planned concurrent surgery, he will remove the pterygium first to avoid having any MMC "in an eye that's potentially leaky or open." After the graft is secure, he'll remove the cataract and use a lower concentra- tion of MMC. "The duration is also much shorter—no longer than a minute— during simultaneous cataract sur- gery," he said. When planning concurrent sur- gery, it's "absolutely necessary" the wound is water tight, he said. "If there's any question the wound might leak, I'll put a suture in because of the antimetabolites," he said. "I cannot overemphasize the need to check the wound metic- ulously. Ensure the conjunctival graft closes any area the MMC might have touched." Sparing patients an additional surgery is the typical reason cited for combining them, presuming K read- ings are stable, the surgeons said. "If the patient is undergoing si- multaneous surgery, do not treat astigmatism," Dr. Palmon said. "It's impossible to tell how much is being caused by the pterygium. I will im- plant a standard lens—not a toric— and I won't do corneal relaxing inci- sions in these patients. It's easy if the patient has no induced cylinder and a small pterygium. But if some- one has 1 D of astigmatism and it's in the axis that might be caused by pterygium, how much is pterygium- February 2011 September 2011 Challenging cataract cases Poll Size: 574 EyeWorld Monthly Pulse EyeWorld Monthly Pulse is a monthly reader pulse on trends and patterns for the practicing ophthalmologist. Each month we send a short 4-6 question online survey covering different topics so our readers can see how they compare to our survey. If you would like to join the current 1,000+ physicians who take a minute a month to share their views, please send us an email and we will add your name. Email: ksalerni@eyeworld.org and put EW Pulse in the subject line; that's all it takes. Copyright EyeWorld 2011 continued on page 70 by Faith A. Hayden M IRA Foundation USA, an organization that pairs guide dogs with children between the ages 11 and 16, has honored the late Gale Martin, M.D., founder of Carolina Eye Associates (CEA), Pinehurst, N.C., and a world-renowned ophthalmologist specializing in cataract and refractive surgery. MIRA is naming two of its guide dogs "Gale" and "Martin" after the ophthalmologist, who succumbed to cancer in 2008. CEA has been instrumental in backing MIRA over the last few years. Thanks to its support in 2010, MIRA was able to provide a guide dog to an 11- year-old girl in California. CEA's support of the Founda- tion continues, allowing the organization to pair six students with guide dogs in the coming months. "Carolina Eye's support has been critical to our abil- ity to increase our candidates for guide dogs from two in 2010 to six in 2011," said Beth Daniels, executive direc- tor, MIRA USA. "We already have five students who have contacted us for next year's program, and we have con- tacted a number of eye clinics around the country to in- vite them to join Carolina Eye as a Corporate Visionary Partner. It would not be an understatement to say that Carolina Eye has set the bar for ophthalmologists around the country." MIRA Foundation honors Dr. Gale Martin Two guide dogs named after the world-renowned ophthalmologist

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