Eyeworld

65 EW RESIDENTS August 2016 significantly different using torsion- al versus longitudinal ultrasound. EW References 1. Global Data on Visual Impairments 2010. WHO 2012. 2. Lindstrom R. Thoughts on Cataract Surgery: 2015. Review of Ophthalmology. March 9, 2015. 3. Nair M, et al. Retained lens nuclear frag- ment presenting years after phacoemulsifica- tion. J Cataract Refract Surg. 2014;40:1752. 4. de Castro LE, et al. Bead-flow pattern: quantification of fluid movement during tor- sional and longitudinal phacoemulsification. J Cataract Refract Surg. 2010;36:1018–1023. Contact information Kapadia: Manasvee.Kapadia@UHhospitals.org phacoemulsification surgery is affected directly by the corneal wound and sleeve complex. From video analysis of fluid flow intraop- eratively and with model eyes they conclude a fulcrum effect is created by the corneal wound, which di- rectly constrains the silicone sleeve and disengages it from the needle tip. Those movements ultimately obstruct fluid at one port and sub- sequently create an excess of fluid from the unobstructed port. They conclude that fluid flow dynamics may directly affect fluttering of the iris in IFIS, and could explain the etiology of retained nuclear lens material in the vitreous in the set- ting of an intact posterior capsule. The authors also demonstrated that the fluid dynamics were not fluid infusion during clinical observations" THE NEW STANDARD IN GLAUCOMA IMPLANT PATCH GRAFTS EASY-PEEL PACKAGING Patented easy-peel packaging allows for quick introduction of sterile tissues to the surgical field, saving valuable OR time. 99.9% CLARITY Unlike traditional patches, Halo tissue grafts are clear and will remain clear, resulting in simplified post-op assessment and improved patient cosmesis. STABLE STORAGE Halo tissues can remain at room temperature and never need reconstitution, so you'll always be ready for emergencies as well as scheduled procedures. Developed at Lions VisionGift's renowned Vision Research Laboratory, Halo sterile tissues provide surgeons with distinct procedural and cosmetic benefits. NOW AVAILABLE Cornea, Sclera & Pericardium © Copyright 2016 Lions VisionGift and Stephens Instruments ( 800 ) 354-7848 stephensinst.com halo@stephensinst.com Distributed exclusively through For more information visit halograft.org Untoward events associated with aberrant fluid infusion during cataract surgery: A laboratory study with corroborative clinical observations Richard Koplin, MD, David Ritterband, MD, Jack Dodick, MD, Eric Donnenfeld, MD, Mark Schafer, PhD J Cataract Refract Surg (Aug.) 2016;42:1135–1140. Purpose: To determine the relationship between untoward events noted during phacoemulsification (PE) surgery associated with aberrant and infusion misdirection and their causal relationship to current infusion sleeve design Setting: The New York Eye & Ear Infirmary of Mt. Sinai, New York Design: Retrospective evaluation of live surgery and experimental study Methods: Observations of live cataract surgery were documented with high definition videography (HDV) and studied at both normal and slow motion speeds using three commercial PE platforms. Laboratory studies using a Photron MC2 high speed camera and the Kitaro cataract surgical system were used to simulate surgical maneuvers and assess flow patterns and visualize the dynamics of fluid movement within the anterior chamber. Color flow Doppler ultrasound studies were used to demonstrate how infusion fluid can impact the iris during surgery. Results: Misdirected infusion and flopping of the iris leaflets were determined to be secondary to a fulcrum effect at the corneal wound that constrained the movement of the standard silicone sleeves. As a consequence, the PE needles were observed to be free to decenter independently of the infusion sleeve, attenuating infusion volume down one side of the sleeve or the other and, as a result, obstructing fluid exiting one or the other distal port. Conclusions: Untoward events associated with aberrant fluid infusion during routine PE surgery were secondary to a fulcrum effect at the corneal wound. Complications, including misdirected infusion facilitating the transport of retained nuclear fragments to the vitreous, inconsistent lens followability during phacoemulsification, and exaggerated movements of the iris particularly consistent with IFIS and pseudoexfoliation. These findings may be associated with current PE needle-sleeve designs.

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