Eyeworld

EW CATARACT 32 October 2017 Pharmacologic agents Some surgeons use pharmacologic agents to dilate patients' pupils. Dr. Crandall said he uses them in all cases. "I use 1% lidocaine with epinephrine, non-preserved, which dilates the pupil. I like to do that because it gives me an idea of the floppiness of the iris, and it also works very quickly. I use that to start 100% of my cases," he said. Omidria (phenylephrine and ke- torolac, Omeros, Seattle) is gaining popularity. It is added to the irrigat- ing solution prior to surgery. IFIS cases For patients with intraoperative floppy iris syndrome (IFIS), Dr. Kenyon said that no preoperative strategy has been found to work. "I find that the best solution is a mechanical one, so I choose rings and hooks very readily. I don't think that Omidria has any application in patients with IFIS. It's not only the pupillary dilation, it's the consis- tency of the pupillary tissue, which becomes very trampoline-like. It needs mechanical support, as the rings tend to afford very definitive- ly," he said. Dr. Malyugin said that IFIS can sometimes be anticipated. "Studies have shown that patients whose pu- pils are less than 7.0 mm have an in- creased chance of having IFIS. Their chance is four times greater than patient with regularly well-dilated pupils. With IFIS, I think that inject- ing phenylephrine or epinephrine intracamerally is helpful because it both strengthens the iris muscle and dilates the pupil. In IFIS, I do not rely solely on the highly viscous OVD to flatten and stabilize the iris because it washes out and does not stay in the chamber long enough to complete the lens evacuation. There are two sizes of the Malyugin Ring— one is 6.25 mm in diameter and the other is 7.0 mm. My preference in IFIS is the 7.0-mm ring, which provides the pupil size of 6.5 mm. In many cases, when you start doing surgery and then face IFIS leading to iris billowing and pupil constriction, you stop and remove the phaco needle from the eye. Then you inject OVD, and the pupil becomes wide again. In that case, the larger ring fits better," he said. Dr. Crandall uses the Malyugin Ring in these patients. "The newer Malyugin Ring is a little thinner. It is very easy to use. Viscoelastic agents are stable, easy to get in, easy to get out, and don't require any addition- al incisions," he said. Dr. Crandall noted that it is im- perative for surgeons to understand the value of each of the devices. "For an IFIS patient with a normal iris, the Malyugin Ring works easily. But it's only going to give you 6.5 mm. If you need more, then you will need an iris hook. For patients with very dense cataracts, surgeons can use a Malyugin Ring, but it's difficult to bring up the harder, denser nuclei. It's helpful to have all the different devices available," he said. EW Editors' note: Dr. Kenyon has financial interests with Beaver-Visitec Interna- tional. Dr. Malyugin has financial interests with MST. Dr. Crandall has no financial interests related to his comments. Contact information Crandall: candy.turnbull@hsc.utah.edu Kenyon: kenrkenyon@cs.com Malyugin: boris.malyugin@gmail.com teChNOLOgiCAL iNNOVAtiON to uncover critical information optomap ultra-widefield imaging is a proven tool for effective clinical decision making. more than 400 peer reviewed studies show the value of optomap imaging in diagnosis, treatment planning, and patient engagement to improve practice flow optomap imaging is so fast and easy it can speed clinic flow giving you more time for high value activities. Routine use of optomap can increase patient throughput by 3-5 patients per day to help prevent vision loss optomap non-mydriatic ultra-widefield technology delivers detailed 200º high resolution images in less than half a second. this technology can image pathology past the vortex vessels, helping you find disease sooner and treat it more effectively pRACtiCe effiCieNCY CLiNiCAL OutCOmeS the ONLY 200° single-capture fa image ▶ optomap ® imaging takes less than half a second... the ONLY 200° single-capture color image Visit us at AAO booth # 3726 or Contact us for your risk-free evaluation at 800-854-3039 or BDS@optos.com Building The Retina Company ©2017 Optos. All rights reserved. Optos ® , optos ® and optomap ® are registered trademarks of Optos plc. GA-00315 /1 optos.com the ONLY 200° single-capture af image r1_Optos_Pillar MD ISLANDAd_AAO EYENET_080317.qxp_Full pg 9/20/17 12:52 PM Page 1 Update continued from page 30

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