61
EW CORNEA
May 2017
with instruments and constrict-
ing the pupil with miotics to help
protect the lens. He also keeps the
pupil constricted in pseudophakic
eyes unless he needs to evaluate lens
position or stability or if he antici-
pates IOL repositioning or exchange.
Additionally, a scleral fixation ring
can help avoid scleral collapse,
which may be more common in
pseudophakic eyes—especially those
that have undergone vitrectomy.
When performing an IOL
exchange that involves replacing a
rigid anterior chamber lens with a
flexible four-point fixation anterior
chamber lens or suturing a posteri-
or chamber lens where the pupil is
not treated postop, Dr. Van Meter
constricts the pupil with Miochol
(acetylcholine chloride intraocular
solution, Novartis, Basel, Switzer-
land) drops intraoperatively or
dilates it with epinephrine in the
irrigating solution.
Graft size
Dr. Van Meter generally oversizes the
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One-day postop image without slit beam of PK patient treated for anterior stromal and
endothelial level scars from past herpetic infection.
continued on page 64
One-day postop image with slit beam of PK patient treated for anterior stromal and
endothelial level scars from past herpetic infection.
