Eyeworld

Reporting from the 2017 EyeWorld Surgical Summit, February 2–4 2017, Park City, Utah EW MEETING REPORTER 132 Reporting from the 2017 EyeWorld Surgical Summit, February 2–4, 2017, Park City, Utah In terms of IOL adherence to the plunger and trapped IOL trailing haptic, this occurred in 0% of Ul- traSert and iSert cases, and 50–60% in iTec cases. Overall, all the systems evaluat- ed successfully placed the IOL in the capsular bag, which was the end- point goal. Editors' note: Dr. Lane has financial in- terests with Alcon and Abbott Medical Optics. Tackling cases of positive and negative dysphotopsia Dysphotopsia is a subjective, un- wanted optical image in pseudopha- kic patients. Nicole Fram, MD, Los Angeles, described positive dyspho- topsia symptoms as including light streaks or arcs, flashes, starbursts, and shimmering. These symptoms usually begin postop day 1 and persist. Negative dysphotopsia—pre- senting as a temporal, arc-shaped shadow—is also present postop day 1, but improves over time, Dr. Fram said. Dr. Fram said positive dyspho- topsia seems to be edge induced, specifically related with square-edge IOLs, which actually present an advantage in preventing posterior capsule opacification. Manufacturers have made some modifications to In the end, Dr. Cionni said the patient was happy with the out- come and his best potential vision is 20/100. Editors' note: Dr. Cionni has financial interest with Abbott Medical Optics, Al- con, ClarVista (Aliso Viejo, California), Morcher, OcuMetrics (Mountain View, California), Omeros, and ReVision Optics. Evaluating preloaded IOL systems Stephen Lane, MD, Stillwater, Min- nesota, led Friday's programming with a presentation on preloaded IOL systems. Advantages of preloaded sys- tems include simplified procedure, reduced operation time, reduced variability in loading, and avoidance of potential errors, such as scratches on the lens. Dr. Lane described research that looked at three preloaded delivery systems—UltraSert (Alcon), HOYA iSert (HOYA Surgical Optics, Singa- pore), TECNIS iTec (Abbott Medical Optics, Abbott Park, Illinois)—and Monarch IOL Delivery System (Al- con) as the manual control with the IOLs injected into porcine models. The UltraSert had the least cor- neal wound enlargement and final incision size. All delivery systems had stress lines, while some showed tip damage or even tip splitting. There are many challenges in the developing world, Dr. Crandall said, including the large number of patients needing to be treated by one or only a few ophthalmologists, depending on the area. He described his work in many different countries around the world, including the Navajo National Eye Care Initiative in the U.S. "Healthcare is not an expense, it's an investment," Dr. Crandall said. Editors' note: Dr. Crandall has fi- nancial interests with Alcon, Omeros (Seattle), Glaukos, and Ivantis. Video session starts with tragedies, finishes with triumphs Thursday's late afternoon video session featured cases that were particularly tough or traumatic but ultimately ended up fine, despite surgical difficulties at times. Robert Cionni, MD, Salt Lake City, shared one of his toughest cases of 2016. The patient was a 31-year-old who suffered a screw- driver to the eye. The accident happened in 2012 and was followed by multiple surgeries through 2013. After the initial repairs, the patient would eventually experience retinal detachment and traumatic glauco- ma. For the latter, he had an Ahmed Glaucoma Valve (New World Medi- cal, Rancho Cucamonga, California) placed. The patient also had bullous keratopathy/corneal scar, requiring penetrating keratoplasty. By 2016 the patient was aphakic and complaining of glare. He want- ed an artificial iris and lens implant. The first segment of Dr. Cionni's vid- eo showed suturing of the IOL at the haptic junction to the artificial iris. This preparation of the implant took 10 to 15 minutes, Dr. Cionni said. Dr. Cionni created four scleroto- mies and made a 6-mm incision. He put the leading Gore-Tex suture in, but found himself struggling with the large incision and pres- sure in the eye. Despite infusion, Dr. Cionni said the eye was like a "smooshed grape," difficult to work in. He closed the incision temporar- ily while working inside to at least maintain the chamber. March 2017 continued on page 134 View videos from Surgical Summit 2017: EWrePlay.org Robert Cionni, MD, Salt Lake City, discusses advantages and techniques for capsular tension rings and sutured segment placement for the management of dislocated IOLs. Sponsored by

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