Eyeworld

EW CATARACT 35 November 2016 designed forceps for this technique is available from Epsilon Instru- ments [Chino, California]." Christian Hester, MD, Little Rock, Arkansas, said, "I would plan to do the case under general anes- thesia. After making my standard paracentesis for bimanual irrigation and aspiration, I would inject Triesence [triamcinolone, Alcon] di- luted 1:10 with balance salt solution to clearly identify all vitreous in the anterior chamber. "I would fill the anterior chamber with a cohesive ophthal- mic viscosurgical device (OVD) and attempt to remove as much vitreous as possible with my MST [MicroSurgical Technology, Red- mond, Washington] scissors and forceps. It may be necessary to use a small gauge vitrector through one of the paracentesis side ports to remove some of the vitreous. I would then use the OVD cannula and Koch spatula to break the iris adhesions from the anterior lens capsule. Once the iris is free I would place one to two temporal iris retractors. I would make the incisions for the retractors just posterior to the limbus where the conjunctiva inserts in order to leave room for my main phacoemul- sification incision and a capsular tension segment that may need to be sutured more posterior. "I would remove the cohesive OVD and place a dispersive OVD over any clear communication between the anterior chamber and vitreous before staining the anterior capsule with trypan blue under air in order to avoid trypan entering the posterior segment, which could con- siderably compromise the view later in the case. I would then initiate the capsulorhexis with my sharp MST Seibel capsulorhexis forceps and anticipate having to use my small gauge MST scissors to complete the rhexis in the area where the iris had fibrosed to the anterior lens cap- sule. Since there is a likely posterior capsule rent, I would use a dispersive OVD to viscodissect the lens as an- terior as possible before proceeding with careful phacoemulsification and small gauge bimanual anterior vitrectomy as needed. "My goal during phacoemulsi- fication would be to preserve 360 degrees of sturdy anterior capsular support, which may require suturing a capsular tension segment. Given the high likelihood of a posteri- or capsular rent, I would plan on placing a monofocal three-piece IOL consider placing paired 30-degree limbal relaxing incisions along the steep axis to reduce some of the astigmatism." in the sulcus with optic capture in order to give me the most future options to manage any long-term IOL complications. Finally, I would TVG Surgical Gonio Lens [ Control the Globe ] Developed in collaboration with: Dr. Steven D. Vold For better control, comfortable positioning, clearer image and minimal corneal pressure, choose the TVG Surgical Gonio Lens for MIGS. > Stabilizes & controls the globe > Floating lens minimizes pressure on the cornea > Visualizes angle in primary phaco position > Ambidextrous design > Compatible with both steam & gas sterilization A Revolution in MIGS Find out more at volk.com/tvg continued on page 36

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