Eyeworld

World view Managing the tough cases T his issue of EyeWorld features tips and techniques for best approaching complex and challenging cataract cases. We are fortunate to have been able to ask some of the world's most renowned surgeons how to manage tough cases and avoid complications for the best possible outcomes for our patients. Cataract surgery can be complicated by zonu- lar issues, and our experts, Bonnie Henderson, MD, Robert Cionni, MD, Steven Safran, MD, and Ike Ahmed, MD, share tips and tricks on how to avoid issues by being vigilant with recognition preoperatively and having the correct tools in the OR to help manage any issues that arise. We move on to face the issue of lack of capsular support for IOL im- plantation. This can be a challenge, and Richard Hoffman, MD, and Amar Agarwal, MD, share their thoughts on the best method—from an ACIOL to sutured or glued in PCIOLs. It is good to have an armamentarium of tech- niques as every eye is different. Next we face the long and the short of it: dealing with those eyes on the extremes of axial length. Richard Tipperman MD, Quentin Allen, MD, and Uday Devgan, MD, challenge us to think outside the box for these cases and modify the intraoperative approach to minimize issues. They also stress the importance of IOL selection for these patients and using the modified formulae. Every eye has its unique architecture, and challenges not only arise with the cataract surgery itself but when dealing with ocular comorbidi- ties. It's important to understand how these may affect our techniques and outcomes. We learn tips from Preeya Gupta, MD, Nathan Radcliffe, MD, Chirag Shah, MD, and Timothy Olsen, MD, on how best to approach our cataract patients with ocular surface disease, underlying glaucoma, and AMD to optimize their outcomes. Rock hard intumescent cataracts pose many challenges throughout the case. Kendall Donaldson, MD, Stephen Lane, MD, and Mitchell Weikert, MD, walk us through the procedure step by step to help minimize complica- tions and maximize outcomes with these tricky cases. These and many more interesting insights into dealing with complex and challenging cases are presented in this issue. An overlying message is that communicating these challenges to the patient is key. Also, it is always best to know our own surgical limitations and perhaps refer when necessary. EW Rosa Braga-Mele, MD, FRCSC, cataract editor The official publication of the American Society of Cataract & Refractive Surgery A S C R S October 2015 Volume 20 • No. 10 Publisher Donald R. Long don@eyeworld.org Editorial Editor Amy Goldenberg amy@eyeworld.org Managing Editor Stacy Jablonski 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 Bradenton, Fla. Michelle Dalton Reading, Pa. Matt Young Malaysia Rich Daly Arlington, Va. Senior Contributing Writer Maxine Lipner Nyack, N.Y. 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