Eyeworld

EW MEETING REPORTER 144 March 2018 Reporting from the 2018 Surgical Summit, February 1–3, Park City, Utah In this case, Dr. Cionni used a standard ring, and it was stable and centered. The end result was a slightly dilated pupil, but it was much im- proved, Dr. Cionni said. The patient was 20/30 uncorrected in the first week and thrilled with the result. In another presentation, Dr. Snyder discussed cataract surgery in nanophthalmos. This can pose a number of issues: tight quarters for anterior chamber surgical ma- neuvers, posterior pressure during surgery, difficult IOL calculations, limited IOL power availabilities, zonulopathies, and high risks for cili- ary effusions or malignant glaucoma. He shared several preemp- tive maneuvers he uses for these patients, including intravenous mannitol, the reverse Trendelenburg position, and general anesthesia. He said that intravenous man- nitol can help reduce both vitreous volume and orbital congestion. The reverse Trendelenburg position and general anesthesia can reduce orbital congestion and peri- orbital venous pressure. Paralytics reduce rectus muscle action/posteri- or pressure. Dr. Snyder said there are other helpful tips for these cases, includ- ing using a CTR and using atropine postoperatively. Editors' note: The speakers have finan- cial interests with various ophthalmic companies. Alan Crandall Lecture This year's Alan Crandall lecture was given by Samuel Masket, MD, Los Angeles, on the topic of "Cat- aract Surgery in the Presence of the Abnormal Cornea." Dr. Masket said there are a number of ways the cornea can be abnormal, and his lecture focused on stromal disease, the post-refractive cornea, surface disorders, endothelial disease, and corneal shape abnormalities. Dr. Cionni agreed that he did not have a clear view, and it was unclear if plaque would interfere with the capsulotomy. Dr. Masket said that while Dr. Cionni prefers OVD, he prefers cap- sule support hooks. Nicole Fram, MD, Los Angeles, agreed that hooks can help because they become artificial zonules and can provide countertraction. In addition to hydrodissection, Dr. Cionni suggested using disper- sive viscoelastic to expand the bag in this case. Dr. Snyder noted that even when capsular hooks may help in a case, they're not a "free pass." With the opening required to make a cap- sular hook opening, you could still get fluid egress, he said. "You don't want the chamber to shallow," added Nick Mamalis, MD, Salt Lake City. He said that putting in OVD before coming out is im- portant to get the chamber formed. Dr. Cionni questioned other panelists on what type of ring they would use in this case. Dr. Masket said he would start with a stan- dard ring and see how well the bag centers. If you need more, put in a single segment. Cataract surgery challenges To kick off the program, Robert Cionni, MD, Salt Lake City, shared a case of a traumatic cataract and iris repair in a patient who was 50 years old and had had an air hose injury to the eye 20 years earlier. Dr. Ci- onni shared details of the case, with panelists weighing in on how they would have handled the situation. When questioned about chal- lenges and how to first react, Sam- uel Masket, MD, Los Angeles, said that one thing you need to be aware of is if there is vitreous coming around the lens and in the anterior chamber. "You want to be certain that you're identifying vitreous," he said. If you're uncertain, put a stain in, and if you're certain there is no vitreous, start by laying dispersive OVD over the open area. Do this repeatedly so you don't bring the vitreous forward. For Dr. Cionni's case, there was some synechiae, and he initially put in hooks. When suturing the iris, you could get some hemorrhage, he noted. At this time, Dr. Cionni pro- ceeded with the capsulotomy. Michael Snyder, MD, Cincinna- ti, noted that he would use stain in the case because the view was tough. Reporting from the 2018 EyeWorld From left: Alan Crandall, MD, Robert Cionni, MD, Michael Snyder, MD, Darcy Wolsey, MD, Mitchell Weikert, MD, Nicole Fram, MD, Kendall Donaldson, MD, and Doug Koch, MD, at the 2018 EyeWorld Surgical Summit. Source: EyeWorld Sponsored by

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