Eyeworld

EW CATARACT 49 September 2016 Editors' note: Drs. Chang, Kim, and Zavodni have no financial interests re- lated to their comments. Dr. Burger has financial interests with Alcon. Contact information Burger: Berdine.Burger@carolinaeyecare.com Chang: dceye@earthlink.net Kim: kim@professionaleye.com Zavodni: zacharyzavodni@gmail.com of nuclear pieces within the eye and thus increase surgical time, Dr. Zavodni said it is to the patient's benefit with the hope of a lower complication rate. Current ASCRS members can watch the original webinar at phaco. ascrs.org/video/phacofun-expecting- unexpected. EW particularly thick, you may expect pressure on the bag and a tear out on your capsulorhexis. If the cham- ber is particularly shallow you won't want to prolapse the nucleus due to endothelial damage and may want to add a cohesive viscoelastic to maintain the anterior chamber." While setting changes to em- phasize safety might slow the speed duration of this added power, and increase percent torsional. Chang- ing this setting restricts the use of added phaco power to parts of the case where it is needed and can help limit corneal edema and endothelial cell damage," Dr. Burger said. "If there is trouble impaling lens mate- rial while chopping, consider adding phaco power in 'burst' settings. Increase vacuum to improve hold on nuclear material, and increase aspiration rate to improve follow- ability and make sure the phaco tip stays cool." Anterior capsular tear In the event of an anterior capsular tear that does not extend past the equator, Dr. Kim said the first thing to do is assess the situation, putting a dispersive viscoelastic in the bag— but not so much as to worsen the tear—then pull out your phaco tip. "When you do this, you'll prevent vitreous from coming out," he said. "Once you've determined the anterior capsule tear has not extended posteriorly, the key is to do cortical removal starting 180 degrees away from the tear." Once you reach the last pieces of cortex near the tear, Dr. Kim said if you're really concerned about pulling it and causing a complica- tion, it can be left alone. Finally, Dr. Kim said a three-piece lens can go in the sulcus with the haptics perpen- dicular to the tear, but not a one- piece lens, which could rub against the iris and cause uveitis-glauco- ma-hyphema (UGH) syndrome. A one-piece lens can be put in the bag, however, with the haptics perpen- dicular to the tear. Preparation Being prepared for some of these more complicated cases before even heading into the operating room is preferred. "We don't stress the clinical exam enough," Dr. Burger said. "Before surgery, you can be prepared for many of these difficult cases with a thorough slit lamp exam. Look for fibrillary exfoliation material on the lens capsule, have the patient move his or her eye left and right to look for phacodonesis. Know whether or not they've had prior trauma or retinal surgery. It also helps me to know what to expect when I look at biometry immediately prior to the case, especially the anterior chamber depth and lens thickness measure- ments. For example, if the lens is

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