Eyeworld

EW MEETING REPORTER 150 Reporting from the 2018 Surgical Summit, February 1–3, Park City, Utah Dr. Weikert shared information on amniotic membrane. He described the properties that make it ideal for treating the ocular surface. It's anti-angiogenic; it has no expression of histocompatibility antigens; it's antibacterial/anti-ad- hesive; it promotes epithelial cell migration and differentiation; it reinforces basal epithelial cell adhe- sion; and it diminishes epithelial cell apoptosis. The two types that are avail- able, he said, are cryopreserved and dehydrated. He also described spe- cific amniotic membrane products available. So, what are the applications for amniotic membrane? It can be used for non-healing corneal epithelial defects from a number of causes including neurotrophic keratopathy, recurrent erosion, bullous keratop- athy, and exposure keratopathy. It may also be used for chemical/ thermal injury, Stevens-Johnson syndrome/ocular cicatricial pemphi- goid, infectious keratitis and corneal ulcers/perforation, in ocular surface disease/dry eye, and ocular surface reconstruction. EW Editors' note: Dr. Weikert has no finan- cial interests related to his presentation. tery should be low and one should not touch the haptic directly during flange creation. Wound positioning is a key step, Dr. Weikert continued, explaining that the incisions for the haptics should be 180 degrees apart and angled. The needle should be about 5 degrees when going in then angled down to 20 degrees. IOL centration is another con- sideration with this technique with several cases being presented where the haptics either needed to be repo- sitioned or cut and recauterized. Other pearls given throughout the roundtable included taking down the conjunctiva enough, using a chamber maintainer, and practic- ing before you go into the OR for the first time. Editors' note: The speakers have finan- cial interests with various ophthalmic companies. The front of the eye: where it all begins A session examined a variety of topics including the current status of LASIK, topo-guided LASIK, compli- cations when using the femtosecond laser for LASIK flap creation, cross- linking, superficial keratectomy, amniotic membrane, and ocular surface disease. During the session, Something all cataract surgeons will have to face are posterior polar cataracts, said Samuel Masket, MD, Los Angeles. It's first important to tell the patient this cataract carries increased surgical risk with a higher incidence of capsule rupture. Sizing and placement of the capsulotomy is important with these patients in order to allow for adequate IOL capture even if the posterior capsule ruptures. As such, Dr. Masket thinks there is a strong case for use of an automated capsulotomy device. However, he avoids nuclear fragmentation with the femtosecond laser to avoid gas bubble distention of the bag. After creating a centered cap- sulotomy, Dr. Masket performs hy- drodelineation (not hydrodissection) using the Vasavada modification of "inside out" delineation. He is sure to use low flow settings, prevents chamber shallowing, emulsifies the nucleus without rotation, and performs viscodissection of the epi- nucleus and cortex with a dispersive OVD. Do not polish the posterior capsule in these cases, Dr. Masket said. Editors' note: The speakers have finan- cial interests with various ophthalmic companies. Yamane roundtable A roundtable provided pearls and pitfalls of the double-needle, flanged intrascleral haptic fixation technique pioneered by Shin Yamane, MD. Mitchell Weikert, MD, Hous- ton, provided some quick pearls for the various stages of the technique. He recommended using a 30-gauge needle because you need a larger lumen to feed the haptics. He also advised testing both haptics in their respective needles before beginning the case to ensure they will fit. IOLs that work for this tech- nique, Dr. Weikert said, include the MA60AC (Alcon) and the ZA9003 (Johnson & Johnson Vision, Santa Ana, California), both of which have PMMA haptics, and the EC-3PAL (Carl Zeiss Meditec, Jena, Germany), which has what Dr. Weikert called "indestructible" PVDF haptics. Cau- March 2018 View videos from the 2018 Surgical Summit: EWrePlay.org Sumit "Sam" Garg, MD, discusses a case of capsular complications and how to stabilize the capsule in cases of weakness. Sponsored by

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