EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
Issue link: https://digital.eyeworld.org/i/387844
The official public tion of the American Society of Cataract & Refractive Surgery A S C R S October 2014 Volume 19 • No. 10 Publisher Donald R. Long don@eyeworld.org Editorial Editor Erin L. Boyle erin@eyeworld.org Managing Editor Stacy Majewicz stacy@eyeworld.org Staff Writer Ellen Stodola ellen@eyeworld.org Staff Writer Lauren Lipuma lauren@eyeworld.org Production Graphic Designer Julio Guerrero julio@eyeworld.org Graphic Design Assistant Susan Steury susan@eyeworld.org Production Manager Cathy Stern cathy@eyeworld.org 703-383-5702 Production Assistant Carly Peterson carly@eyeworld.org Contributing Writers Vanessa Caceres Lakeland, Fla. Michelle Dalton Reading, Pa. Matt Young Malaysia Enette Ngoei Dublin Rich Daly Arlington, Va. Senior Contributing Writer Maxine Lipner Nyack, N.Y. Advertising Sales ASCRSMedia 4000 Legato Road Suite 700 Fairfax, VA 22033 703-591-2220 fax: 703-591-0614 eyeworld@eyeworld.org www.eyeworld.org Advertising Sales Jeff Brownstein jeff@eyeworld.org 703-788-5745 Paul Zelin paul@eyeworld.org 703-383-5729 Classified Sales Cathy Stern cathy@eyeworld.org 703-383-5702 EyeWorld Special Projects and Events Jessica Donohoe jessica@eyeworld.org 703-591-2220 ASCRS Publisher: EyeWorld (ISSN 1089-0084) is published monthly by ASCRS Ophthalmic Services Corp., 4000 Legato Road, Suite 700, Fairfax, VA 22033-4055; telephone: 703-591-2220; fax: 703-591-0614. Printed in the U.S. Editorial Offices EyeWorld News Service, 4000 Legato Road, Suite 700, Fairfax, VA 22033-4055; toll-free: 800-451-1339, 703-591-2220; fax: 703-591-0614; email: eyeworld@eyeworld.org. Advertising Offices ASCRSMedia, 4000 Legato Road, Suite 700, Fairfax, VA 22033-4055; toll-free: 800-451-1339, 703-591-2220; fax: 703-591-0614; email: eyeworld@eyeworld.org. 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Periodical postage paid at Fairfax, VA 22033 and at additional mailing offices The ideas and opinions expressed in EyeWorld do not necessarily reflect those of the editors, publisher, or its advertisers. P U B L I S H I N G S T A F F World view Complex cataract cases A medical student who was rotating through the ophthalmology clinical clerkship asked me if I ever become bored with performing the same type of surgery. While an observer may view cataract extraction as simple and monoto- nous, most cataract surgeons would agree that each case is different and can be surprisingly diffi- cult. In fact, the complication rate for posterior capsular tears and/or vitreous loss is on average 1–2%. This means that although most surgeries have successful outcomes, a busy surgeon could encounter a complication nearly every month. This issue's focus is complex cataract cases. There are many complicated scenarios, but we are highlighting the most common situations including pseudoexfoliation (PXF), dense/mature cataracts, small pupils, dislocated intraocular lenses (IOLs), and secondary lens implantation. Steven Gedde, MD, John Hart, MD, and JoAnn Giaconi, MD, discuss the common preoperative signs of PXF. They review the intraoperative man- agement including the ongoing debate of implanting capsular tension rings as a prophylaxis in all patients with PXF. While PXF can be one of the causes of poor dilation, there are other etiologies. Laura Green, MD, Preeya Gupta, MD, and Michael Summerfield, MD present some of the surprising associations between medications and poor pupillary dilation. They also describe adjuvant intraoperative tools that can assist in visualization. Jeff Pettey, MD, and Timothy Page, MD, not only encounter dense cat- aract overseas, they also find them in patients in the U.S. They ecommend proper preop counseling regarding the difficulties of removing mature lens. Often surgical techniques and machine fluidics must be alter d to tackle these dense cataracts. Even the IOL power calculations can be difficult. When the primary cataract surgery is completed, the eye is not "out of the woods" yet. In eyes with other pre-existing morbidities, late complica- tions can occur. Recently many surgeons have noticed a higher incidence of late IOL dislocations. It is unclear whether more IOLs are indeed becoming dislocated, or whether patients are living longer and remaining physically active longer and therefore late complications are more apparent. Regardless, Minu Mathen, MD, Soosan Jacob, FRCS, and Richard Hoffman, MD, describe techniques for managing these difficult cases. Finally, Richard Davidson, MD, Natalie Afshari, MD, and Bryan S. Lee, MD, discuss their preferred methods for secondary lens implantation, focusing on specific techniques, the best IOL, sutures, and me ication regimens. For those who perform cataract surgery, there is never a lack of difficult cases, so the risk of boredom is slim. The best approach is to prepare as if every case is complex, as one never knows when a mundane case will quickly switch over to a heart-pounding, difficult one. EW Bonnie An Henderson, MD, cataract editor EyeWorld @EWNews Keep up on the latest in ophthalmology! Follow EyeWorld on Twitter at twitter.com/EWNews