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EW CATARACT 45 September 2015 When doing irrigation and aspira- tion, avoid blind maneuvers, Dr. Malyugin said. With conventional CTRs, you can support missing or weakened zonules by circularizing the bag and evenly redistributing zonular tension between the remain- ing zonules, he said. Also, center the capsular bag if there are sufficient zonules and tighten the posterior capsule. If the CTR is implanted before cortical material is completely evacuated from the capsular bag, bimanual irrigation/aspiration is helpful in evacuating the lens fibers trapped in the bag fornix by the CTR. Dr. Malyugin's third pearl related to using conventional CTR and OVD. When you are implant- ing the CTR, first inject a bolus of viscoelastic right below the level of the anterior capsulorhexis opening. He said surgeons should use the CTR as soon as they know there is a problem. This can range from immediately after the rhexis to after the IOL is in place. There are special considerations at each stage, he said. The fourth pearl was the importance of the fish-tail technique of conven- tional CTR implantation. This can help avoid zonular stress, he said. But a modified CTR that can be su- tured to the sclera may be necessary, which was the fifth pearl. There are contraindications, and he specified times that surgeons may not want to implant a CTR. These include if there is a radial tear-out of the rhexis, if there is a posterior capsule tear, or if there is a high risk of a wraparound tear where the CTR would end up in the vitreous. For patients with pseudoexfoliation syndrome and loose zonules, Dr. Malyugin recommended being pre- pared for a number of different sur- gical scenarios. Have your CTRs and capsular hooks ready, he said. EW Editors' note: The physicians have no financial interests related to this article. Contact information Bhattacharjee: suvenb@gmail.com Chee: chee.soon.phaik@snec.com.sg Malyugin: boris.malyugin@gmail.com McGhee: c.mcghee@auckland.ac.nz Sun: grs2003@med.cornell.edu An NSAID formulated to penetrate target ocular tissues PROLENSA ® POWERED FOR PENETRATION Available in a 3-mL bottle size Please see brief summary of Prescribing Information on adjacent page. References: 1. PROLENSA ® Prescribing Information, April 2013. 2. Data on file, Bausch & Lomb Incorporated. 3. Baklayan GA, Patterson HM, Song CK, Gow JA, McNamara TR. 24-hour evaluation of the ocular distribution of 14C-labeled bromfenac following topical instillation into the eyes of New Zealand White rabbits. J Ocul Pharmacol Ther. 2008;24(4):392-398. 4. BROMDAY ® Prescribing Information, October 2012. ®/™ are trademarks of Bausch & Lomb Incorporated or its affiliates. © 2015 Bausch & Lomb Incorporated. All rights reserved. Printed in USA. US/PRA/15/0015 PROLENSA ® delivers potency and corneal penetration with QD efficacy 1,2 • Advanced formulation delivers corneal penetration 1-3 • Proven efficacy at a low concentration 1,4 INDICATIONS AND USAGE PROLENSA ® (bromfenac ophthalmic solution) 0.07% is a nonsteroidal anti‑inflammatory drug (NSAID) indicated for the treatment of postoperative inflammation and reduction of ocular pain in patients who have undergone cataract surgery. IMPORTANT SAFETY INFORMATION ABOUT PROLENSA ® Warnings and Precautions • Sulfite allergic reactions • Slow or delayed healing • Potential for cross‑sensitivity • Increased bleeding of ocular tissues • Corneal effects, including keratitis • Contact lens wear Adverse Reactions The most commonly reported adverse reactions in 3%‑8% of patients were anterior chamber inflammation, foreign body sensation, eye pain, photophobia, and blurred vision. " Don't be a cowboy. There's no ego in patient care. When you think you can get away with not doing something, you may get lucky ... but not always. " –Grace Sun, MD

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