Eyeworld

EW MEETING REPORTER 128 September 2016 Reporting from the 2016 COS A session at the Combined Ophthalmic Symposium (COS) focused on cata- ract surgery—"basics and beyond." Robert Cionni, MD, Salt Lake City, provided surgical pearls that he said make a differ- ence in his practice. The first was a one-handed cataract surgery tech- nique with a pre-chopper, which he said seems to result in clearer corneas and makes it easier to seal side-port incisions. Dr. Cionni suggested leaving irrigation off as you enter the cham- ber, turning it on only after you put a second instrument under the iris to prevent reverse pupillary block. For coloboma repair, Dr. Cionni said instead of bringing the iris together inferiorly and closing the coloboma, use intraocular scissors to separate the peripheral sphincter tis- sue from the more central sphincter tissue, connecting the central leaflets of the iris. "Now, when we have constric- tion of the pupil, it won't be pulling down toward the limbus. It will pull much more like a normal pupil," Dr. Cionni said. Zaina Al-Mohtaseb, MD, Houston, discussed options for lens implantation when there isn't ade- quate capsular support. Advantages of scleral sutured IOLs include similar positioning to a crystalline lens, minimal trauma to the cornea and angle, and reduced risk for secondary glaucoma or pu- pillary block. The procedure, howev- er, is technically more complex with larger incisions, requires anterior vitrectomy, and has other possible complications. Iris fixation, which Dr. Al- Mohtaseb said she doesn't perform often, has a smaller incision size and is a faster procedure. However, she said to accommodate the procedure the iris must be normal. It also runs the risk of late IOL dislocation, uveitis, glaucoma, cystoid macular edema, and pupil distortion. Dr. Al-Mohtaseb said in some complicated cases anterior chamber intraocular lenses are "completely fine." "The newer, open-loop designs are much better tolerated, but the key is to make sure that it's placed correctly, the size is correct" to avoid possible complications like cystoid macular edema, she said. If a patient has ever used alpha- blockers, which are commonly prescribed to treat prostate issues, Alan Crandall, MD, Salt Lake City, said the ophthalmologist should know about it and prepare for the possibility of intraoperative floppy iris syndrome. "The problem is a history of pri- or [use of these medications]. Many patients are asked 'Are you taking them?' You have to ask, 'Have you ever been on them?'" Dr. Crandall said, going on to show images of iris atrophy in patients who had taken tamsulosin. "The problem is it is permanent. … It can happen after just one single dose." Richard Lindstrom, MD, Minneapolis, spoke about options for dropless or fewer drop cataract surgeries, which can cost signifi- cantly less, can be more efficient, and can improve the issue of patient compliance. He also presented on a sublingual, patent-pending con- scious sedation formula, MKO Melt (Imprimis Pharmaceuticals, San Diego), that could benefit patients with IV phobias or where IVs are difficult to start. Editors' note: Dr. Cionni has finan- cial interests with Alcon (Fort Worth, Texas), ClarVista Medical (Aliso Viejo, California), Lenstec (St. Petersburg, Florida), Mile High Ophthalmics (Denver), Morcher (Stuttgart, Germa- ny), Ocumetics Technology Corporation (Surry, British Columbia), Omeros (Seattle), and ReVision Optics (Lake Forest, California). Dr. Al-Mohtaseb has no financial interests related to her comments. Dr. Crandall has financial interests with Alcon, ASICO (West- mont, Illinois), Esinomed (Prutting, Germany), and Omeros. Dr. Lindstrom has financial interests with Imprimis, Alcon, Abbott Medical Optics (Abbott Park, Illinois), Bausch + Lomb (Bridge- water, New Jersey), Valeant Pharma- ceuticals International (Laval, Cana- da), and Allergan (Dublin). Update on retinal vein occlusions A retina session covered topics including treatments for wet and dry AMD, retinal vein occlusion, pars plana vitrectomy, and diabetic retinopathy. Christina Weng, MD, Houston, highlighted retinal vein occlusions (RVOs). "It's interesting that we don't talk about RVOs as Sponsored by Reporting from the 2016 Combined Ophthalmic Symposium (COS), August 26–28, 2016, Austin, Texas

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