Eyeworld

5 Supported by unrestricted educational grants from Abbott Medical Optics, Alcon Laboratories, and Bausch + Lomb C ataract surgeons can alter their phacoemul- sification settings in complicated cases, such as intraoperative floppy iris syndrome (IFIS), brunescent cataracts, and soft posterior polar cataracts. Intraoperative floppy iris syndrome "One of the recent greater chal- lenges for the cataract surgeon is the floppy iris patient," said Lisa Park, MD, associate professor and associate director of residency training, Department of Oph- thalmology, New York University School of Medicine. "The first Brunescent cataract A common question about phaco chopping is how to hold onto a lens fragment, said Bonnie An Henderson, MD, clinical profes- sor of ophthalmology, Tufts Uni- versity School of Medicine, and in private practice with Ophthalmic Consultants of Boston (Figure 1). One way is to increase the vacuum. "But if you increase your vacuum, you have to make sure you're keeping your chamber stable, so you want to think about increasing your bottle height or your inflow if you want to drasti- cally increase your vacuum," said and cohesive beneath to push back the iris. Dr. Park prefers to use a ring for IFIS cases. During phaco, she brings the pieces up and out rath- er than performing phaco in the bag. "My personal feeling is that when you have this floppy iris, everything flops," she said. Once she has observed a floppy iris, although she is work- ing through a 2.2- or 2.4-mm wound, she closes the wound. "This can easily come up and out, and that can be a source of endophthalmitis, so I tend to close my wound in those cases," she said. thing I'm going to say is prepara- tion is everything." A careful patient history is essential. The role of tamsulosin in IFIS has been widely discussed, but clinicians should also ask patients about other alpha-1 adrenergic blockers. "In women, terazosin and doxazosin that are being used for blood pressure have been implicated," Dr. Park said. She often stains with trypan blue in these cases. "I do this because if you're going to run into a problem, it's nice to make sure you can really see the cap- sule," she said. Then she uses an Arshinoff shell. She uses a disper- sive to protect the endothelium Altering phaco settings for complicated cases Figure 4. Sculpting settings for the Centurion, presented by Lisa Park, MD Figure 3. Sculpting settings for the Infiniti for a soft nucleus, presented by Lisa Park, MD continued on page 6 continued from page 4 The Centurion utilizes a balanced salt solution bag, so the surgeon cannot see the change in bottle height. The display shows instead the intraocular pressure (IOP) and the amount of fluid remaining in the bag. "Because this is an active system, there are sensors in the cartridge, which are going to continuously feed back and pump in the fluid to main- tain that IOP," she said. For sculpting with the Centurion, she uses similar settings as with the Infiniti: bottle height, 95; low vacuum; and low aspiration (Figure 4). During quadrant removal, IOP is approximately 80 mmHg, which is equivalent to a bottle height of approximately 110. She uses a vacuum setting of 475, which is higher than the Infiniti, and aspiration flow is approximately the same. "I found that the Centurion is very powerful, and I at the same time converted to the balanced tip, which has a greater excur- sion," Dr. Park said. "So the ability to plow through a very dense lens increased dramatically."

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