Eyeworld

World view Challenge accepted: Complicated cataract surgery C ataract surgery is an ever-evolving and exciting field with new technologies emerging frequently. Many of these new technologies have helped make cataract surgery more timely and efficient. However, there are many times that we as surgeons face challenges and complications in surgery. It's always helpful to have an armamen- tarium of different techniques and technologies to try and maximize our outcomes. In this series on challenging and complicated cataract surgery, we have the ability to call on many different surgeons for their tips and expertise in different scenarios. We learn how best to strategize if a complication occurs and the posterior capsule ruptures. Even with the best of planning and in the best of hands, we encounter intraoperative surprises. It is important to have a game plan, recognize the situation, and react accordingly. Lisa Arbisser, MD, Bryan Lee, MD, and John Berdahl, MD, take us through early and next steps, how to utilize triamcinolone, how to approach any vitreous loss, and IOL placement. Another situation that we see more frequently due to retinal procedures and injections is the post-vitrectomized eye. We have cataract surgeons Richard Tipperman, MD, Kevin Miller, MD, Uday Devgan, MD, and Bonnie An Henderson, MD, along with retinal specialist Ehsan Rahimy, MD, help us understand the best timing after retinal procedures to perform cataract surgery as well as tips for enhancing preoperative evaluation. We learn about intraoperative adjustments to optimize surgery, as well as how to set patient expectations with these cases. Sometimes, what should appear to be "easy" can become one of the more challenging cases we encounter. The soft cataract is the perfect example. The challenges faced with these lenses are eloquently outlined by Elizabeth Yeu, MD, David Hardten, MD, and Deepinder Dhaliwal, MD. They give us strategies for rhexis formation, viscoelastic choices, phaco machine settings, and general tips and techniques. When dealing with posterior polar cataracts, Steven Safran, MD, and Clara Chan, MD, share recommendations on how to diagnose these cases, prepare for them, and try to avoid complications due to the inherent nature of the cataracts. IFIS and the small pupil can unfortunately be a challenge we encounter often due to medication use or pseudoexfoliation. It is important in these cases to be able to recognize the situation and have a good intraoperative plan. Thomas Samuelson, MD, Michael Greenwood, MD, and Garry Condon, MD, offer excellent tips and tricks for dealing with the unpredictable or small pupil. I hope you enjoy this issue and learn a new tip or trick that makes your next case a little bit easier. It is so beneficial to share ideas among colleagues, and their tips hopefully will make these cases seem a bit less challenging. EW Rosa Braga-Mele, MD, Cataract editor The official publication of the American Society of Cataract & Refractive Surgery A S C R S October 2016 Volume 21 • No. 10 Publisher Donald R. Long don@eyeworld.org Editorial Editor Amy Goldenberg amy@eyeworld.org Managing Editor Stacy Jablonski stacy@eyeworld.org Senior Staff Writer/Digital Editor Ellen Stodola ellen@eyeworld.org Staff Writer Liz Hillman liz@eyeworld.org Production Graphic Designer Julio Guerrero julio@eyeworld.org Graphic Design Assistant Susan Steury susan@eyeworld.org Production Manager Cathy Stern cathy@eyeworld.org Production Assistant Carly Peterson carly@eyeworld.org Contributing Writers Stefanie Petrou Binder, MD Berlin, Germany Vanessa Caceres Bradenton, Florida Michelle Dalton Reading, Pennsylvania Rich Daly Arlington, Virginia Lauren Lipuma Washington, D.C. Senior Contributing Writer Maxine Lipner Nyack, New York Advertising Sales ASCRSMedia 4000 Legato Road Suite 700 Fairfax, VA 22033 703-591-2220 fax: 703-591-0614 eyeworld@eyeworld.org www.eyeworld.org Paul Zelin paul@eyeworld.org 703-383-5729 Classified Sales Cathy Stern cathy@eyeworld.org 703-383-5702 EyeWorld Special Projects and Events Jessica Donohoe jessica@eyeworld.org Shelly Dixon shelly@eyeworld.org ASCRS Publisher: EyeWorld (ISSN 1089-0084) is published monthly by ASCRS Ophthalmic Services Corp., 4000 Legato Road, Suite 700, Fairfax, VA 22033-4055; telephone: 703-591-2220; fax: 703-591-0614. Printed in the U.S. Editorial Offices: EyeWorld News Service, 4000 Legato Road, Suite 700, Fairfax, VA 22033-4055; toll-free: 800-451-1339, 703-591-2220; fax: 703-591-0614; email: eyeworld@eyeworld.org. Advertising Offices: ASCRSMedia, 4000 Legato Road, Suite 700, Fairfax, VA 22033-4055; toll-free: 800-451-1339, 703-591-2220; fax: 703-591-0614; email: eyeworld@eyeworld.org. 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