EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
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March 2012 EW CATARACT 67 light irides, he will likely do an LPI first. "Whenever possible, I try to avoid cataract surgery in a hot, in- flamed eye," he said. Dr. Vold also recommends goniosynechialysis in cases of residual synechiae of rela- tively short duration. "I explain to everyone there's a price to be paid," Dr. Rhee said. "20/20 on an eye chart with a PCIOL is not the same as 20/20 with your natural crystalline lens. But for patients who are predisposed to angle-closure (meaning the con- tralateral eye has already had an at- tack), it's essentially a preventative procedure with good outcomes." That said, if a patient has had an acute attack in one eye already, "[the patient is] completely on board with the fellow eye surgery since the at- tack is so bad," Dr. Rhee said. In Dr. Cui's study, patients re- ceiving LPI were assumed to require a subsequent trabeculectomy, she said, and both lens exchange and trab "were assumed to lead to en- dophthalmitis with subsequent vi- sion loss at low probabilities" estimated from the literature. "Our model and results are likely to be conservative, since by design, complications of trabeculec- tomy are not currently included in our analysis/decision tree; more de- tailed analyses are expected to be more favorable to lens extraction," she told EyeWorld in an email. The softer lenses in younger pa- tients also mean the chamber is more shallow, "with an anterior cap- sule that's more like a dome; the rhexis is also more difficult to per- form, or there's at least more of a chance it'll go out on you," Dr. Rhee said. Dr. Rhee "personally likes pre- chopping" in these patients since the lens is so soft. "A 20/20 cataract is much more difficult to remove than a 20/50 cataract," he said. Dr. Vold suggested avoiding dilation until mid-surgery. "I use lidocaine with preserva- tive-free epinephrine and then vis- coelastic to prevent an acute attack while the patient's on the table," he said. "Hyperopes are absolutely ec- static because we're correcting two of their problems." He also sug- gested operating a "little more poste- riorly within the capsular bag, to Toll free 1-888-519-5375 www.oculususa.com sales@oculususa.com www.pentacam.com protect the corneal endothelium. We want an outstanding outcome, espe- cially for those with clear lenses." EW Editors' note: The doctors mentioned have no financial interests related to this article. Contact information Cui: 585-350-6764, qi_cui@urmc.rochester.edu Rhee: 617-573-3670, dougrhee@aol.com Vold: 479-366-4570, svold@cox.net OCULUS Pentacam® /Pentacam® The indispensable tool for anterior segment analysis • Anterior and posterior corneal topography • 3D Cataract analysis • Evaluation of corneal optical quality for premium IOLs • Holladay Report for post-refractive IOL calculations • NEW Iris camera and automatic HWTW measurement • NEW Belin/Ambrosio 3, improved for Hyperopic eyes • LASIK Screening Join us at the ASCRS in Chicago - Booth #1609 HR facebook.com/OCULUSusa