OCT 2012

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

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Page 98 of 168

October 2012 Panel continued from page 94 Most patients tolerate small misalignments; otherwise, it is important to re-evaluate the whole process before repositioning the IOL surgically Eduardo Soriano, M.D. Dr. Trindade: Before surgery, with the patient sitting upright at the slit lamp, I place reference marks, at the periphery of the cornea, on each side of the 0-180 degree meridian. There are many ways to make these reference marks, varying from surgeon to surgeon. If the patient happens to be unhappy with the surgical outcome, because of im- proper alignment of the toric lens, I would take him/her back to the operating room, as soon as possible, to rotate the lens back into the cor- rect position, with OVD assistance. Dr. Soriano: I like to use a bubble level marker and a speculum to determine the meridians of 3 and 9 o'clock, while the patient is sitting, before sedation or a block. Then intraoperatively, I use a gauge and a pen to mark the meridians of the lens and the incision. An important detail is that the marks are aligned with the visual axis/center of the cornea. It is also good to avoid using too much anesthetic eye drop to re- duce the risk of epithelial injury, as well as using viscoelastic substance in the cornea only after marking. Most patients tolerate small mis- alignments; otherwise, it is impor- tant to re-evaluate the whole process before repositioning the IOL surgi- cally, trying to not wait too long to prevent fibrosis of haptics to hinder the release of the lens. Dr. Nosé: I use a pendulum corneal marker to mark the patient while upright, in order to compensate for cyclotorsion. The lens axis mark is made after the lens implantation with the toric axis marker, then the lens is aligned with the marks. If we note any misalignment in the post-op period, which in our ex- perience has been very rare, we can easily rotate the lens with a Sinskey hook under topical anesthesia if the rotation is visually significant. Dr. Casanova: I mark the corneal astigmatism axis and the placement of the corneal incision at the slit lamp according to the toric IOL calculator. I do not use reference marks at 180 degrees because I do not use any other device to mark in the OR. Marking at the slit lamp avoids ocular cyclotorsion and allows me to confirm the correct corneal axis using the angle marker. In the OR, theses marks are en- hanced under the microscope. I use a sharp point pen to avoid large marks that can cause mild misalign- ment. The point must be positioned perpendicularly to the cornea to avoid blurring. I have never performed a surgi- cal reintervention for toric IOL repo- sitioning. These lenses have a great stability in the capsular bag. How- ever, if necessary, it should not be difficult. After injecting viscoelastic inside the bag, the IOL can be easily rotated using a Lester hook to be centered or placed on the right axis. EW Editors' note: The physicians have no financial interests related to this article. Contact information Casanova: fhccasanova@uol.com.br Ghanem: ramonghanem@gmail.com Nosé: wnose@me.com Padilha: mpadilha@domain.com.br Soriano: dusoriano@gmail.com Trindade: fernandotrindade@mac.com Zacharias: wzacharias@terra.com.br

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