Eyeworld

129 October 2015 EW MEETING REPORTER and it didn't stay in the bag. Dr. Davidson trimmed the edges and tucked them behind the optic so they wouldn't chafe the iris. Even with these improvements, the pa- tient still had retina issues and some pain problems following the IOL exchange. EW Editors' note: Drs. Davidson and Tipperman have no financial interests related to their comments. involved a 51-year-old woman who had cataract surgery 10 months prior and had gotten a Crystalens (Bausch + Lomb, Bridgewater, N.J.). But about 6 weeks after surgery, she began to have severe pain and decreased vision. She had 20/150 uncorrected vision. When Dr. Davidson examined the patient, her Crystalens was in the bag but was back posteriorly. After doing an OCT, he saw she had a phimotic capsule. The real issue, he said. This is something that physicians may not realize the importance of but actually plays a big role in surgery. "You don't realize how much muscle tension you have when you sit and do a lot of cases," Dr. Tipperman said. When you have a busy surgical schedule, the natural tendency is to run through the case to get it done, but over the years, that creates a lot of "micro injuries," he said. Introducing intraoperative aberrometry and adapting to it has been the biggest change in Dr. Tipperman's OR. He uses the ORA with VerifEye+. This has necessitated a number of small but significant changes in Dr. Tipperman's ap- proach to draping patients. About 10 years ago, based on a presentation at the ASCRS• ASOA Symposium & Congress, Dr. Tipperman said that most surgeons at his ASC started using hydroxypro- pyl methylcellulose at the beginning of cataract surgery to help keep the cornea clear and moist. However, since he began using intraoperative aberrometry, he has stopped using hydroxypropyl methylcellulose for these cases because it interfered with obtaining sharp corneal images and quick, accurate readings. The induction of intraoperative aberrometry has also influenced Dr. Tipperman's decision to use a bladed or a wire speculum. He previously preferred the bladed speculum, but he finds that the wire speculum is more effective in aberrometry cases because there is less potential for globe compression, particularly in toric IOL cases. However, using a wire specu- lum also increases the possibility of lashes being present in the surgical field. This requires consideration in draping because the presence of lashes can alter the astigmatic mea- surement with the aberrometry. Dr. Tipperman said that he is starting to drape these patients by using foam adhesive dressing, which helps en- sure that the lashes are isolated from the surgical field. Choosing an IOL exchange can be a complicated decision for a patient, and Richard Davidson, MD, Aurora, Colo., discussed one such case that he handled. The case he said, was getting the lens out because there was only about a 2.5 mm opening. Dr. Davidson chose to do an IOL exchange and use the laser to cut a new capsulotomy. "With Crystalens exchanges, it's rare that I can get the haptics out," Dr. Davidson said, because they are usually very fibrotic. In this case, he ended up cutting along the hinge and trimming back the edges. A 3-piece lens was inserted in the bag, just in case something happened That goes for the newest technology from OCULUS Capture the object accurately – calculate its length precisely – and SNAP! The chameleon fascinates us with its surprisingly swift, high-precision hunting technique. What do you think this chameleon would say if you asked it whether length matters? And what does all of this have to do with our latest product highlight? Find out at www.length-matters.com The latest OCULUS technology – learn more at our lunch symposium during the AAO 2015 in Las Vegas on Sunday, November 15, 2015 at 12:15pm. Register online: www.aao.org/eyenetlunchreg Length matters! *OCULUS is not affiliated with the official program of AAO 2015. Visit the OCULUS Booth #2243 at AAO 2015 facebook.com / OCULUSusa Toll free 1-888-519-5375 ads@oculususa.com www.oculususa.com

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