Eyeworld

Reporting from the 2017 ASCRS•ASOA Symposium & Congress, May 5–9, 2017, Los Angeles EW MEETING REPORTER 90 June 2017 Sponsored by with the capsule or the IOL itself. In this case, just removing the cells improved the patient's vision. Dr. Chang offered the tip of not rotating the lens in cases of weak zonules when there is a radial tear in the capsule to avoid wraparound. Dr. Henderson presented photodynamic therapy (crosslinking with riboflavin or using rose bengal and green light) to treat infections that have persist- ed despite other interventions. Dr. Hovanesian's case highlighted why physicians should beware of mak- ing decisions based on pachymetry when there are visual issues in the presence of an intracorneal inlay. Dr. Lane showed a case of pseudoexfoli- ation where the lens was looser than expected during cataract surgery; capsular tension hooks provided stability, viscoelastic helped stabilize the bag, and a CTR was placed due to the possibility of late lens disloca- tion in this patient. Editors' note: Dr. Lane has financial interests with Alcon and ClarVista. Dr. Slade has financial interests with Carl Zeiss Meditec. Dr. Chang has financial interests with Carl Zeiss Meditec and Johnson & Johnson Vision. Dr. Hovanesian has financial interests with AcuFocus (Irvine, California). Dr. Henderson has no financial interests related to her comments. (Rysurg, Palm Beach, Florida), which he demonstrated cleans off even stubborn biofilms and crust. He cit- ed data that showed increased tear breakup time, improved symptom scores, and increased OSDI scores with this technique. Dr. Lane said using technolo- gy to assess the tear film to test for quality can give you images to show patients, helping them understand their condition visually and perhaps encouraging compliance with ther- apy. Dr. Slade discussed amniotic membrane, which can be used preop or postop to heal the ocular surface. Though Dr. Henderson was jok- ingly voted the winner in the "Pearls for management of astigmatism" category, despite not presenting, Dr. Donnenfeld called it a draw between Drs. Chang and Lane, who discussed tips for the malpositioned IOL and figuring out the axis of alignment of an existing IOL with the app Axis Assistant, respectively. Dr. Slade won the category for "Complication management," offering a decision tree to help phy- sicians decide on whether a multi- focal IOL should be exchanged if the patient is unhappy or if another intervention could save the case. In one case, Dr. Slade simply had to vacuum the capsule of cells under the IOL, which allowed him to better identify whether the issue was In this category, Dr. Henderson spoke about a technique to prevent negative dysphotopsias; Dr. Hova- nesian offered "bite-size" cataract surgery pearls; Dr. Lane discussed the Transformer I/A handpiece (Alcon,); and Dr. Slade shared how he talks with patients about the relatively new small incision lent- icule extraction (SMILE) refractive procedure. Dr. Chang was voted as offer- ing the best new technology on the horizon. He spoke about the MILOOP (IanTECH, Reno, Nevada), which is a nitinol loop that circles cataracts for manual chopping. Dr. Chang said this disposable, FDA-approved device can be used on both soft and dense lenses, but it's the dense lenses where he said the device will provide a "wonderful adjunct." Dr. Henderson discussed a portable OCT for self-monitoring. Dr. Hovanesian spoke about using software to help better patient care and experience, while Dr. Lane talked about the Harmony modular IOL (ClarVista Medical, Aliso Viejo, California). For the "Best tip in getting started in refractive surgery," Dr. Henderson was voted by the audi- ence as the winning instructor for offering tips on helping physicians feel more comfortable with multi- focal IOLs. Dr. Henderson advised having a game plan; performing a thorough preoperative exam to rule out coexisting eye diseases and con- traindications; performing compre- hensive counseling; and managing the patient's expectations. Dr. Chang offered pearls for avoiding rotation; Dr. Hovanesian suggested performing limbal relax- ing incisions without charge to get comfortable correcting astigmatism surgically; and Dr. Slade advised to avoid vitreous loss at all costs because expectations are so high in this group and you don't want to have to explain why you couldn't put in a toric or multifocal IOL. The best tip for managing ocular surface disease went to Dr. Hovane- sian for his presentation on mi- croblepharoexfoliation with BlephEx View videos from ASCRS•ASOA Los Angeles: EWrePlay.org Fernando Trindade, MD, discusses the utility of an intraocular pinhole implant for patients with highly irregular corneas.

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