EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
Issue link: https://digital.eyeworld.org/i/78719
February 2011 February 2012 EW GLAUCOMA 85 of graft dislocation," he said. "This will work in those patients with fairly well encapsulated blebs. In pa- tients with porous blebs, the air can potentially escape into the subcon- junctival space and cause diffuse ecchymosis and flat chamber." Other strategies to combat air leakage, said Dr. Lehrer, consist of plugging tubes or putting a plug or stent inside a tube in order to main- tain a better air bubble. There are also descriptions of people perform- ing a trabeculectomy using vis- coelastic, but Dr. Lehrer is wary of that approach. "The viscoelastic can sometimes Successful DSEK in a patient with an inferior nasal tube Source: Ramesh S. Ayyala, M.D. allowing the air to be retained in the anterior chamber, explained Dr. Ayyala. "Some people overfill the cham- ber with the air bubble such that air fills the tube until it can be seen in the subconjunctival space causing back pressure that may keep the air bubble from leaking out to the point get in the way of adherence to the graft, so that can be problematic," he said. "I try to stay away from vis- coelastic during DSEK if possible. In many cases you can get an air bub- ble to maintain without going through all these gyrations." Another issue that can arise is making a graft too large, thus caus- ing it to actually touch the tube or EX-PRESS shunt. Both Drs. Lehrer and Ayyala emphasized the impor- tance of tailoring the surgery to each individual eye but were able to give a few general pearls. For instance, Dr. Lehrer suggested making the graft a bit smaller than normal in order to prevent such a complica- tion. "If I normally use an 8-8.5 mm, for example, I might use a 7.5 or 7.75 mm graft," he said. "Some people have described using a pair of scissors to cut a notch out of the graft in order to accommodate a tube or a shut. I think by making the graft a bit smaller you can avoid doing that. It's a potentially danger- ous situation to start hacking into the graft." continued on page 86 Stab Knives for Side Port or Scleral Incision 15, 22.5, 30, 45 degree Phaco Slit Knives for Clear Corneal or Scleral Incision 2.5, 2.65, 2.75, 2.85, 3.0, 3.2, 3.5 mm Crescent Knives for Scleral Tunnel Incision 2.0 mm MVR Knives for Vitreoretinal Infusion Port for Paracentesis Incision 19, 20, 23 GA Straight • 20, 23 GA Angled Clear Corneal Knives 2.75, 3.0, 3.2 mm Clear Corneal Knives, Parallel Sides 2.75, 3.0, 3.2 mm Double Bevel Sideport Knives 1.0mm, 1.2mm, 1.4mm FM 71198 LABS 10201-A TRADEMARK STREET, RANCHO CUCAMONGA, CA 91730-5850 USA Toll Free: 800 782-6534 Ph: 909 481-0011 • Fx: 909 481-4481 www.eaglelabs.com • email: goeagle@eaglelabs.com © Eagle Laboratories 2012 Yes! I Would Like To Evaluate A Sample Of The Following: The Complete EAGLE Ophthalmic Product Catalog Name Address City Phone# State Contact Name Please Return to Eagle, Attention: Customer Service Zip 0483