Eyeworld

JUN 2012

EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.

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70 EW MEETING REPORTER June 2012 Highlights continued from page 69 Reporting live from the 2012 ASCRS•ASOA Symposium & Congress, Chicago Cornea," Henry F. Edelhauser, Ph.D., Atlanta, conducted a study to de- scribe endothelial cell density (ECD) in glaucoma patients and medica- tions that may impact ECD. Dr. Edelhauser and his colleagues examined four groups of patients: a glaucoma suspect group, a drug therapy group, a surgical therapy group, and a mitomycin-C (MMC) therapy group. Among other things, they found that glaucoma has a direct effect on ECD; both glaucoma surgery and therapy directly affect ECD; and ECD loss is worse in patients treated with MMC during glaucoma ther- apy. Randy J. Epstein, M.D., Chicago, could only agree, saying that, "MMC is a very potent medica- tion with a lot of potential compli- cations." He said it is important to keep MMC from penetrating into the anterior chamber, where toxicity can cause ciliary body damage re- sulting in anterior chamber shallow- ing. Glaucoma surgery itself has di- rect mechanical effects on the cornea, potentially causing Descemet's membrane detachment. Dr. Epstein recommended watching patients being treated with multiple therapies closely to mini- mize complications. Editors' note: Dr. Goldman has finan- cial interests with several pharmaceuti- cal companies that produce glaucoma drops, including Alcon, Allergan (Irvine, Calif.), and Bausch + Lomb (Rochester, N.Y.). Dr. Edelhauser has financial interests with Alcon. Dr. Epstein has financial interests with Alcon and TearScience. Don't make explantation seem taboo Editors' note: This Meeting Reporter contains original reporting by the EyeWorld news team from the 2012 ASCRS•ASOA Symposium & Congress, Chicago. Meeting Reporter sponsored by Alcon. It's OK when the need to explant an IOL arises, and patients should feel comfortable bringing serious com- plaints about their vision post-op to their surgeons, said Kerry D. Solomon, M.D., Charleston, S.C. "I don't want patients to feel like they are disappointing me," Dr. Solomon said at the ASCRS Town Hall program on premium IOLs. Dr. Solomon said he has dealt with IOL A President Obama impersonator entertained meeting attendees Source: Convention Photo by Jeff Orlando exchanges, typically in the 3-6 month window post-op, but also as late as 2 years out. Bradley C. Black, M.D., Baton Rouge, La., goes one step further, offering a refund when the need for explantation arises. Granted, it only happened in one premium IOL case that Dr. Black operated on. "I only had to remove one mul- tifocal," Dr. Black said. "The patient just could not adjust to it. I gave him his money back. If you went and had a dental procedure and you didn't get what you were looking for, you would want your money back, too." Meanwhile, Samuel Masket, M.D., Los Angeles, asked a question that came from the audience. "When do we try to convert a patient who came in the office not wanting a multifocal IOL?" Dr. Black's answer was sup- ported by some of the panelists. "We are obligated to let patients know what's available," Dr. Black said. "If my mother went to see an ophthalmologist and she wasn't told what was available, I would be upset. Sometimes it's a quick presen- tation because [patients] have no in- terest in [premium IOLs], but that's OK." Editors' note: Drs. Solomon, Black, and Masket have no financial interests related to their comments. What to do when the lens wants to do its own thing It almost had the hallmarks of a bad ophthalmology joke, but it was no joke. A 46-year-old man presented at the office of Kerry D. Solomon, M.D., for cataract surgery and achieved 20/25 vision at day 1 post- op. "He comes back 3 weeks later and says, 'I'm not seeing so great,'" Dr. Solomon, Charleston, S.C., said during "X-Rounds: Refractive Cataract Surgery to the Max." The patient's lens had rotated to 45 degrees and he was seeing 20/200. "I took him back to the OR and repositioned him back to 103 de- grees," Dr. Solomon said. Not soon afterward, he returned and the lens had rotated right back to 45 degrees. "I said I would take him back to the OR, but this time [I wouldn't use] viscoelastic," Dr. Solomon said. "At day 1 post-operatively, he was great. At week 1, he said, 'Doc, this is getting old.'" Sure enough, the lens "just wanted to hang out at 45 degrees," Dr. Solomon said. Added Eric D. Donnenfeld, M.D., Long Island, N.Y., jokingly, "Did you think of starting out at 45 degrees?" Ignoring Dr. Donnenfeld's hu- morous "advice," Dr. Solomon said that when he brought the patient back into the OR, "while I had the lens rotated where I wanted it to be, I performed optic capture." Dr. Solomon brought the optic in front of the anterior capsule. "Rotating the haptics so I had the lens where I wanted it to be, the lens stayed perfectly centered," Dr. Solomon said. He added that a cap- sular tension ring would have been another approach, but optic capture worked well and solved the problem. "That is a novel and useful tech- nique," Dr. Donnenfeld said, in all seriousness. EW Editors' note: Drs. Solomon and Donnenfeld have no financial interests related to their comments.

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