Eyeworld

EW CATARACT 33 3360 Scherer Drive, Suite B, St. Petersburg, FL 33716 800-637-4346 • Tel: 727-209-2244 • Fax: 727-341-8123 Email: Info@RheinMedical.com • Website: www.RheinMedical.com *Developed In Coordination With Barry S. Seibel, M.D. Botticelli, Madonna of Pomegranate Seibel* Capsulorrhexis Cystotome Forceps ABBH 1377 Rev.A 05-2363 Call 727-209-2244 For More Information. S i d e C lo s ed V i e w T o p D o w n C l o s e d V i e w T o p D ow n Op e n V i e w S i de O p e n V i e w • Unique Viewport Allows Anterior View Through The Tips To See Exactly Where The Jaws Are Grasping. Ideal For Both Capsule & Other Intra- Ocular Manipulation. • Smoothly Etched Markings On Anterior Surface Of Shaft Provide Full & Half Millimeters On Shaft To Help Neutralize Corneal Magnification By Measuring At The Capsule Plane. • Blunt Tips & Mirror Polished Shaft For Maximum Safety. • Low Actuation Handle Pressure For Optimum Ergonomic Dexterity. • Micro-Coaxial Design Ideal For Maintaining Chamber Stability & Visualization In Small Phaco Incisions As Compared To Conventional Forceps. • Made Of Titanium In The USA, Guaranteed For Life, & Available For A 30-Day Surgical Evaluation Without Obligation. Come See Us At ESCRS Booth No. P240 using imbricating Siepser-style sliding knot sutures. This will likely result in too small of a pupillary aperture, however. After the superior sutures are placed, the inferior iris margin can be gently trimmed with curved microscissors, a small gauge vitrector, or sculpted using light inferior iris stromal 25 g cautery in order to achieve a physiologic pupil- lary aperture." Dr. Groos said, "I would perform a small sphincterotomy at 6 o'clock and McCannel sutures superior to move the pupil to the center of the IOL, after anterior vitrectomy. If dilation relieves her symptoms, isolating the incarcerated portion of the iris is necessary using radial incisions followed by the McCannel repair." Josh Teichman, MD, Toronto, Canada, weighed in as well. "A trial with a colored contact lens with a small pupil aperture may be worth- while. If the IOL is not damaged and of the correct power, a Gore-Tex suture may be used to recenter the IOL using an ab externo docking technique and partial thickness scleral grooves. I would attempt goniosynechialysis to free any iris from the superior wound as this may improve the symptoms and also add real estate that may cover the defect, or be used for pupilloplasty if not Second case The second case is a patient who was 10 years postop from compli- cated cataract surgery. She has been suffering with severe glare for years, and because of this she never drives at night. She has had multiple YAG laser procedures that were done in failed attempts to fix the problem. On examination she has iris incar- cerated in the superior wound, and there is a bridge of capsule support- ing the IOL superiorly with vitreous poking around the edge of the lens into AC. Figures 4 and 5 show the eye prior to dilation. Pilocarpine does not help the situation. What are this patient's options? Dr. Snyder commented, "I find these superior iris defects are usually less of an issue because the upper lid acts as a de facto upper iris, but if there is incarceration of the iris in the wound the pain could be from muscle traction at the point of incar- ceration and not from light scatter. I am having a hard time seeing the IOL optic, but your mention of mul- tiple YAG procedures suggests possi- ble pitting in the superior optic." He continued, "Interestingly, this patient's problem is identical to that of a pseudophakic congenital coloboma patient, except the defect is superior rather than inferior. Giv- en the rather meaty looking stroma, this superior defect could be closed Watch a video of this technique at EyeWorld Clinical rePlay, clinical.ewreplay.org. continued on page 34 Figure 3: Day 1 postop after oversew repair of iris

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