Eyeworld

EW CATARACT 43 January 2018 Contact information Al-Mohtaseb: zaina@bcm.edu Fram: nicfram@yahoo.com an already implanted three-piece lens or other off-the-shelf lens; and its elimination of potential suture exposure, among other reasons. If the bag cannot be saved with a capsular tension ring or ring segments, Dr. Fram said her fixation technique depends on the degree of capsule support. If there is diffuse zonulopathy and an intact anterior or posterior curvilinear capsulorhex- is, one could place haptics in the sulcus and optic capture through the anterior or posterior capsulotomy as described by Howard Gimbel, MD, and popularized by David F. Chang, MD, and Lisa Arbisser, MD. 3 If there is more than 270 de- grees of capsule support and poor zonules not amendable to a CTR or optic capture, a lens could be put in the sulcus and haptics sutured to the iris using 10-0 polypropylene in a McCannel or Siepser fashion, which Dr. Fram said would ensure centration of the IOL over time. Finally, if there is no capsule viability and it needs to be removed, Dr. Fram advised a triamcinolone-as- sisted pars plana anterior vitrectomy and intrascleral haptic fixation, us- ing either the Yamane or glued IOL technique or scleral suture fixation with off-label Gore-Tex. Final tips for young eye surgeons In cases of IOL exchange, Dr. Fram said one should go slowly and have a plan A, B, and C at the ready. New techniques should be practiced with a simulated eye model before head- ing to the OR, she added. "The most important thing is to know your own limits," Dr. Al- Mohtaseb said. "If there is signifi- cant zonular loss or if the IOL I want to remove is too dislocated (which I can tell when I lay the patient back in clinic), I ask my retina colleagues to do a combined case with me in which they remove the lens and I insert the secondary IOL using the Yamane technique. It is always better to be safe than heroic in these cases." EW References 1. Kim EJ, et al. Refractive outcomes after multifocal intraocular lens exchange. J Cata- ract Refract Surg. 2017;43:761–766. 2. Brunin G, et al. Secondary intraocular lens implantation: Complication rates, visual acuity, and refractive outcomes. J Cataract Refract Surg. 2017;43:369–376. 3. Gimbel HV, et al. Intraocular lens optic cap- ture. J Cataract Refract Surg. 2004;30:200–6. Editors' note: The physicians have no financial interests related to their comments. Are You a Phaco Surgeon Interested in Compassionate Surgery in the Developing World? Our Charity Delivers High-Volume, Well-Equipped Phacoemulsification Projects to the Impoverished of Mexico. We are Now Recruiting Volunteer Phaco Surgeons for Our Upcoming Surgical Projects in 2018. Learn More About Us and Contact Us at: www.choseneyemission.com

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