Eyeworld

71 EW FEATURE October 2015 Complex cataract cases expectancy of the patient," said Steve Safran, MD, in private prac- tice, Lawrenceville, N.J. Iqbal "Ike" K. Ahmed, MD, as- sistant professor of ophthalmology, University of Toronto, said "it's not a great idea" to use the femtosecond laser in these patients; the capsulot- omy "is not as strong with the femto as with manual, and the capsule is stronger without the femto." He said that capsulotomy strength is particularly important in these cases as capsule hooks and capsular ten- sion devices are used on the capsule edge, and if there is weakness, there is increased risk of tearing, which could not only result in serious complications but prevent the use of a capsular device to support the zonulopathy. Dr. Cionni disagreed, saying "in every case of zonular compro- mise, my strong preference is to use the femtosecond laser. One of the toughest parts of these surgeries is achieving an appropriately sized capsulotomy centered on the lens, not the pupil" and the femto helps reduce the anxiety. "The added benefit of the femto is that you can decenter that capsu- lotomy and very precisely size it to your advantage," Dr. Cionni said. If, however, the lens is suf- ficiently subluxated "there's not enough real estate" to use the femto properly, Dr. Ahmed said. He also recommended referring weak zonule cases if the surgeon is not comfort- able performing a capsulorhexis in those cases. Pearls for identifying zonular deficiencies Both Drs. Safran and Cionni rec- ommended examining the patient in an undilated state, since dilation can "dampen the zonular laxity," Dr. Cionni said. Once the patient is dilated, look for a scalloped edge on the capsular bag, and get "as wide a dilation as you can," he added. "If you try breaking the capsule with your forceps and start seeing capsule wrinkles, or the lens moves a bit, that can give you a subtle tip that the zonules may be weak," Dr. Ahmed said. During manual cap- sulorhexis, "look for capsule striae, look for the capsule to move during capsulorhexis," he said. If there is anterior chamber depth (ACD) asymmetry preoper- atively, or "if the eye goes out of focus constantly and you find your- self needing to focus up and down more frequently than normal during the case, this could also be a sign of weak zonules," Dr. Henderson said. Dr. Ahmed said that in addition to ACD, a posterior chamber that's deeper than normal may be a subtle sign of deficiency. Beaver ® Safety Knives Help Prevent Sharps Injuries Healthcare Worker Safety — More important than ever! Beaver Safety Knives promote: • No-look, single hand activation • Enhanced blade sharpness and consistency Beaver-Visitec offers a broad portfolio of Safety Knives. Over 1000 sharps injuries per day Sustained by US hospital healthcare workers 1 Call your local sales rep or BVI customer service at 1-866-906-8080. Visit us at www.beaver-visitec.com Beaver-Visitec International, Inc., 411 Waverly Oaks Road, Waltham, MA 02452. BVI logo and all other trademarks are property of Beaver-Visitec International (BVI) © 2015 BVI. U.S. patents #D496730, 7022128 and 7387637. Additional U.S. and International patents pending. 1 CDC Sharps Safety Complete Workbook, http://www.cdc.gov/sharpssafety/pdf/workbookcomplete.pdf; CDC Stop Sticks Campaign, http://www.cdc.gov/niosh/stopsticks/sharpsinjuries.html AAO Booth 1221 continued on page 72

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