Eyeworld

EW CATARACT 32 April 2018 Going continued from page 31 JULY 20, 2018 VANCOUVER, BC, CANADA CELEBRATING 10 YEARS OF INNOVATION UNITING OVER 225 LEADERS In the development of ground-breaking ophthalmic technologies WWW.OIS.NET /OIS.NET @OISTWEETS /OPHTALMOLOGYSUMMIT FOUR SEASONS VANCOUVER same technique I used in a previous case with success (see Video 1). Unfortunately, the patient in this video came in 2 years postop- erative—and 1 week after I saw the patient we are currently discussing— and his lassoed hydrophilic acrylic had opacified leading to a decrease in vision. The same week, I was re- ferred another patient with a history of trabeculectomy, RD repair with silicone oil (subsequently removed), and a previous YAG capsulotomy with an opacified Akreos as well (Figure 3). At this point, I was already aware of reports of opacification of Akreos lenses after placement of an air bubble in the eye to perform endothelial keratoplasty, but neither of these two patients had a histo- ry of such procedure so it became clear to me that these hydrophilic acrylic IOLs may opacify over time in complex eyes even without the placement of an air bubble to perform DSAEK or DMEK. With this concern, I decided to abandon my plan to lasso the Akreos lens and instead remove the IOL/capsular bag complex completely by elevating it up into the anterior chamber from a pars plana approach, performing pars plana vitrectomy, cutting and entirely removing the complex and performing a Yamane style double needle intrascleral haptic fixation of a three-piece hydrophobic acrylic EC-3 PAL lens. I also planned to do a goniotomy with a Kahook Dual Blade to help control the IOP (see Video 2). At 1 week postop her vision in this eye was 20/20-2 uncorrected with an IOP of 16 (Figure 4). Figures 5 and 6 demonstrate what the melted haptic tips look like at the slit lamp; they are flush and barely visible. At 1 month the vision remained at 20/20, and IOP was 16 on topical timolol only, so a decision was made to do the cataract surgery in the oth- er eye. This was performed unevent- fully using a Symfony lens (Johnson & Johnson Vision, Santa Ana, Cal- ifornia) along with placement of a CTR resulting in 20/20 uncorrected vision. The patient was very happy with the final outcome. I chose to present this case to highlight the fact that hydrophil- ic acrylic IOLs can opacify over time in eyes that have a history of secondary procedures, and those procedures do not necessarily have to include placement of air or gas in the eye. I think this makes these implants an inappropriate choice for use in complex eyes even though they are relatively easy to suture fixate. It is clear to me that we now have with the Yamane intrascleral haptic fixation approach another alternative that can be used safely through a small incision and that requires no conjunctival dissection. With this technique, we can utilize a hydrophobic acrylic lens that has no history of opacification or degrada- tion over time. I think that this is the safest and most stable current option for these patients that we have available to us. EW Editors' note: The physicians have no financial interests related to their comments. Contact information Riaz: kamranmriaz@gmail.com Rosenfeld: srosenfeldmd@gmail.com Safran: safran12@comcast.net Schulze: richardschulze@comcast.net Ward: mattsward@gmail.com

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