Eyeworld

EW NEWS & OPINION 22 May 2016 You'll notice in the above exam- ple I did not state why there was a capsular rupture and vitreous loss. It may be that there were pre-existing zonular issues, post-polar defects in the posterior capsule, or some other reason that was beyond the surgeon's role. If it was the surgeon's fault, he or she can—and perhaps should—be more clear in his or her role in this complication. If the cleanup was not complete, the IOL differed from plan, or you know the patient will require additional surgery, the surgeon should speak to that at the same time. Again, use terms that have a good chance of being understood by the patient. Of course, you should always reassure the patient that you have expended and will continue to expend all the best efforts to see that he or she has an optimal recovery, whether that simply is to follow him or her carefully, reoperate, or refer to another specialist. Patients with a complication most fear being aban- doned during this time. Vitreous loss in and of itself, if handled properly, is not in my mind a serious com- plication, but each surgeon is going to have to decide that for him- or herself and tailor the conversation accordingly. Designed and Manufactured by NIDEK - Represented by Marco 800-874-5274 • marco.com Changing Perspective for Best Vision Outcomes Hosted by Arun C. Gulani, M.D., M.S. Arun C. Gulani, M.D., M.S. Jacksonville, Florida "We've all felt intimidated by certain complicated cases. But what if we could treat Keratoconus to refractive outcomes, Lasik complications to emmetropia, premium IOL surgery to consistent success and even stage complex situations straight to 20/20? How do we confidently tackle these achievable challenges? When I shifted my focus from 'fixing' patients' specific problems, to optimizing their complete visual system, I learned to deconstruct and simplify stacked conditions that present into treatable components. The result…I've elevated my expectations, equipped myself with the necessary technology to achieve my plan, and I'm enjoying the optimized surgical results that best serve my patients." In June, Marco will launch a series of case studies, Changing Perspective for Best Vision Outcomes, that addresses real challenges that have been tackled with a true 'Vision Plan' of attack. Please look forward to all new series updates. Communicating continued from page 20 We explain vitreous loss in this way: "Hi, Mr. Smith, how does your eye feel? I hope you were comfortable during the surgery. Your cataract is all out and the lens implant is in. Surgery went fine overall. "We encountered a challenge during the surgery but were able to deal with it effectively. Remember our discussion in the office before cataract surgery? A cataract is a cloudy lens that is encased within a bag. When we do cataract surgery, we make an opening in the front of the bag, remove the cloudy lens ma- terial, and replace it with an artificial implant, which is usually placed within the bag. "Toward the end of surgery, we saw an opening in the back part of the lens capsule, and some of the gel called vitreous (which usually stays behind the capsule) was coming forward through the bag opening. We carefully removed some of the vitreous gel to decrease the chance of future problems. "Because of these findings, we made a few modifications and placed the lens implant in a differ- ent and safer position in the eye. I checked the implant at the end of the surgery, and it looked very stable and well positioned. We closed the cataract incision with a stitch, and it is very secure. "We instilled antibiotic and steroid drops in your eye to help it heal. You will start using both these drops per the instruction sheet. It is very important that you do not rub your eyes for the first few weeks after surgery. I will see you tomorrow in the office, and we will check your vision and eye pressure. Your eye might be a little sore, watery, and red today. This is normal after cat- aract surgery. If you have pain that is not relieved by acetaminophen, please call me. My phone number is written on the instruction sheet. Do you have any questions for me?" EW Editors' note: The physicians have no financial interests related to their comments. Contact information Arbisser: drlisa@arbisser.com Blecher: mhbmd@comcast.net Dhaliwal: dhaliwaldk@upmc.edu Sane: sanem@upmc.edu Deepinder Dhaliwal, MD Associate professor of ophthalmology, University of Pittsburgh Medical Center Mona Sane, MD Fellow, cornea and external diseases

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