OCT 2012

EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.

Issue link: https://digital.eyeworld.org/i/87458

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Page 128 of 168

122 EW IN OTHER NEWS October 2012 ECCE in developing countries by Faith A. Hayden EyeWorld Contributing Writer Blindness," did a marvelous job of explaining why ECCE is still a vitally important procedure in many areas of the world. EyeWorld: You presented at the 2012 ASCRS Film Festival a new technique for performing ECCE. Why do you think that surgeons need a better way of doing an old procedure? Post-op rounds in Namibia. Dr. Colvard serves as volunteer surgeon with SEE International Source: Mike Colvard, M.D. W ith the advancement of phacoemulsifica- tion techniques, ex- tracapsular cataract extraction (ECCE) may seem like an outdated proce- dure to many ophthalmologists. In fact, young ophthalmologists may not be familiar with ECCE at all, having little experience performing the technique in the U.S. Despite the advancements in modern cataract surgery, though, ECCE still has a place. Not only can it be used as a fallback technique should phaco go awry, but surgeons like Mike Colvard, M.D., clinical professor of ophthalmology, Univer- sity of Southern California School of Medicine, feel it's the procedure of choice for cataract surgery in developing countries. Dr. Colvard has been volunteer- ing in Africa for more than 20 years as a surgeon with SEE International and believes ECCE is a safer, more practical procedure in underdevel- oped settings. Here's why. EyeWorld: Why do you think that ECCE still has a place in ophthalmic surgery? Dr. Colvard: Advanced cataracts are the most common cause of blind- ness in underdeveloped countries. Patients in these countries often present with extremely dense hyper- mature cataracts. These kinds of cases, as we all know, are also often associated with compromised zonules and tissue thin capsules. Frequently the entire capsular bag is filled with rock hard nuclear mate- rial. These are long, difficult phaco cases in the best of circumstances that often require expensive ancil- lary devices such as dispersive OVDs, capsular expansion rings, and/or capsular support hooks. And even with all this in the best of hands, the risk of capsular tears and retained nuclear material is relatively high. These are the kinds of cases we see only occasionally in private practice in the U.S. So we take the extra time, we use every- thing in the surgery center to make things safer, and if we do have a complication with loss of nuclear material in the vitreous, our exquisitely skilled vitreoretinal surgeons are around to save the day. In underdeveloped countries, virtually every case you face is an extraordinarily dense cataract. ECCE is a better modality in this setting because patient loads are huge, and this procedure is faster, far less expensive, and safer for these kinds of cases, where trained vitreoretinal surgeons are seldom available. David F. Chang, M.D., in the 2009 ASCRS Binkhorst Lecture, titled "The Greatest Challenge in Cataract Sur- gery Needed: 5 minute, $15 Cure for Dr. Colvard: One of the chief reser- vations that most younger surgeons have in volunteering internationally is that they know there is a good chance they will have to perform ECCE—a procedure with which many surgeons have very little expe- rience. While working for years as a volunteer surgeon for SEE Interna- tional, I developed a simple tech- nique that I believe can allow any well-trained phaco surgeon to per- form ECCE with speed and safety. It utilizes variants of maneuvers that phaco surgeons already know how to perform, and it can be learned easily by an experienced phaco sur- geon by just watching our video de- scribing the procedure titled, "ECCE for the Phaco Surgeon: The Slip and Slide Maneuver." My goal in describ- ing this technique is to help younger surgeons to feel comfortable performing ECCE and in that way encourage them to volunteer their skills internationally. EyeWorld: How is your ECCE tech- nique different from the traditional ECCE procedure? Dr. Colvard: The older standard ECCE technique traditionally taught in the U.S. is very difficult to per- form without a lot of practice. It in- volves applying external pressure to the globe opposite the incision in an effort to prolapse the nucleus into the anterior chamber and out of the incision. The "slip and slide maneu- ver" for ECCE is much safer and more easily reproducible. It simply involves tipping an edge of the nu- cleus into the anterior chamber, slip- ping some OVD under the nuclear plate, and then sliding the nucleus into the anterior chamber and out of the eye. This technique protects the capsule and places virtually no pressure on the zonules. Once the nucleus is sitting safely in the ante- rior chamber, removing the nucleus through a funnel shape incision whose internal width is greater than the external width is simple and easy. EyeWorld: You have worked as a vol- unteer surgeon in underdeveloped countries for many years. What motives you to take time out of your busy private practice to volunteer in this way? Dr. Colvard: We eye surgeons have been given a wonderful gift. Through our training we have been given the ability to help blind people see again. It's a gift that's so precious that we must share it, especially with those who need our help most desperately. In our private practices most of the surgery we per- form is done to allow our patients to drive more safely or to read more easily. That's important, but in Africa, Central and South America, India, and the Far East, as volunteer surgeons, we are usually doing sur- gery that is far more life changing. Our efforts allow patients to feed themselves again without help from family members, to walk unassisted, and to see their loved ones. This is an experience that no eye surgeon should miss out on. We have an ex- traordinary gift that's ours to give, and it's a shame for any of us to miss the wonderful opportunity to share our gift with those who need us most. EW Reference Ruit S, Tabin G, Chang D, et al. A prospective randomized clinical trial of phacoemulsifica- tion vs. manual sutureless small-incision extracapsular cataract surgery in Nepal. Am J Ophthalmol. 2007;143(1):32-38. Editors' note: Dr. Colvard has no finan- cial interests related to this article. Contact information Colvard: mike@mcolvard.com

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