Eyeworld

OCT 2014

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

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109 EW RESIDENTS October 2014 NIDEK Inc. 47651 Westinghouse Drive Fremont, California 94539-7474 USA Telephone: 1-800-223-9044 usa.nidek.com NAVEX Quest with Final Fit ™ , topography-assisted excimer laser system featuring CATz software. #14-0023 CATz, our latest innovation in Laser Vision Correction, enables surgeons to treat myopic astigmatism with corneal irregularities. According to George O. Waring III, MD, principle investigator of the US FDA Study, "the outcomes of the CATz study are astoundingly good. 51% of patients see 20/16 or better without correction*." Dr. CATz CoNTACT NIDEK To ElImINATE yoUr USEr FEES ToDAy! P r o d u c t s • s e r v i c e s • t e c h n o l o g i e s • 200Hz Active Eye Tracker. • TED: Torsion Error Detection, captured by the OPD. • Proprietary Final Fit TM software for accurate outcome simulation and customized corneal treatment. • Full Nidek support including customer tailored service options. • No User or Click Fees associated with Nidek Laser use or service. * Pg 29, 7.4.2 FDA Professional Use of Nidek Topography assisted Lasik. The San Francisco fog Debbie Kuo, MD Introduction from Dr. Naseri One of the many great things about training ophthalmology residents is that they can make keen observa- tions and correlations across clinical practices, connecting the dots for unusual diagnoses that might oth- erwise go unnoticed or unexplored. These 2 cases were expertly diag- nosed, managed, and presented by Debbie Kuo, MD, one of our rising senior residents. They reveal a rare complication of a very common procedure: cataract surgery. Discus- sants include Michele Bloomer, MD, Saras Ramanathan, MD, and Cynthia Chiu, MD, all core teach- ing faculty at the Department of Ophthalmology, University of California, San Francisco (UCSF). Case presentation The first patient is an 83-year-old man with a history of wet age-relat- ed macular degeneration receiving monthly anti-VEGF injections in the right eye and Fuchs' corneal dystrophy, who underwent cata- ract extraction and intraocular lens implantation in the right eye 6 years prior and the left eye 3 years prior to presentation. He was transferring care from another facility, where he had been seen the month prior with a baseline vision of 20/60. In our clinic, he reported progressively decreasing vision in the right eye over the last 2 months. On exam, his vision was 20/200 in the right eye without improve- ment with pinhole and 20/25 in the left eye. His intraocular pressure was 15 and 16 in the right and left eyes, respectively. His pupils were reactive bilaterally without an afferent pu- pillary defect. He had normal visual fields to confrontation. Figure 1A shows the slit lamp examination of the right eye, demonstrating a clear cornea with moderate guttae, deep and quiet anterior chamber, normal dilated iris, and a posterior intraocular lens with a milky white fluid positioned between the lens and the posterior capsule. The anatomy was better illustrated by ultrasound biomicros- copy (UBM), showing the posterior capsule bowed away from the intraocular lens (Figure 1B). On indirect ophthalmoscopy, the view of the posterior pole was somewhat limited by the milky fluid, but the optic disc appeared normal and there were no retinal hemorrhages. Optical coherence tomography (OCT) of the macula showed a small pigment epithelial detachment and a pocket of sub- foveal subretinal fluid (Figure 1C), which both appeared unchanged since his last OCT at an outside facility. The second patient is a 63-year- old man with type 2 diabetes result- ing in moderate non-proliferative diabetic retinopathy in the right eye, proliferative diabetic retinopathy in the left eye that was quiescent after panretinal photocoagulation, and diabetic macular edema in both eyes previously treated with focal laser, intravitreal triamcinolone acetonide, and anti-VEGF agents. He was bilaterally pseudophakic after having undergone cataract surgery in both eyes 7 years ago, and had required a YAG capsulotomy in the left eye for posterior capsular opacification 2 years late . continued on page 110 Academic grand rounds Ayman Naseri, MD

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