Eyeworld

World view Challenging cases and innovative solutions W e all experience a challenging case from time to time that tests our surgical skills and ability to man- age these difficult circumstances. When these cases present in my operating room, I often recall the wisdom of the surgeons who we spoke to for this issue of Eye- World. Their insights coupled with modern ad- vanced technology can often be the difference in surgical outcomes. For this issue, we interviewed some of the best surgeons in the fields of cornea, cataract, glaucoma, and refractive surgery. All an- terior segment ophthalmologists will potentially deal with these situations during their careers. In this issue of EyeWorld, we learn how to turn challenging cases into happy postoperative patients. Challenging corneal cases present to every ophthalmologist. Clara Chan, MD, EyeWorld Cornea editor, said ocular surface disease patients can be the most difficult cases she sees, and her treatment options range from managing eyelid abnormalities to stem cell transplantation with system immunosuppression. Amar Agarwal, MD, is one of the most innovative ophthalmologists I have ever met. His videos are works of art, and it is worth visiting the ASCRS website to view them. His most challeng- ing cases revolve around pseudophakic bullous keratopathy. He uses many of his innovative solutions, including the glued IOL technique, PDEK, and single-pass four-throw pupilloplasty. Rosa Braga-Mele, MD, EyeWorld Cataract editor, Kevin Miller, MD, and Richard Tipperman, MD, present three tough cataract cases and how they were managed. At some point in the OR, most of us will experience the Argentinian flag sign, TASS, and operating on a very young patient. These three experts all have a common theme: Have a plan, and have a back-up plan. Keeping the patient as well as the surgeon calm during the procedure can be as important as the surgical management itself. Today cataract and corneal refractive surgery have merged as special- ties. Neel Desai, MD, Daniel Durrie, MD, and I discuss the management of difficult refractive surgery cases and where the future of refractive surgery is heading. Refractive surgery has entered a new era with the ability to resolve refractive errors safely and effectively, as well as rehabilitate some of the most challenging eyes that in the past would have gone on to amblyopia or required a rigid contact lens or even a corneal transplantation. I think that glaucoma patients are among the most challenging cases we see on a regular basis. Three exceptional glaucoma surgeons, Valerie Trub- nik, MD, Nathan Radcliffe, MD, EyeWorld Glaucoma editor, and Robert Rothman, MD, share their experiences and wisdom on managing these difficult cases. They rely on surgical skill, intelligent decision making, and an abundance of exciting new technologies that have truly revolutionized the specialty of glaucoma. EyeWorld salutes the physicians who have contributed to this issue and thanks them for their expertise and willingness to share their stories. While by their very nature challenging cases are the most difficult surgeries we perform, they can also be the most rewarding. EW Eric Donnenfeld, MD, chief medical editor The official publication of the American Society of Cataract & Refractive Surgery A S C R S July 2018 Vol. 23 • No. 7 Publisher Donald Long don@eyeworld.org Editorial Editor Amy Goldenberg amy@eyeworld.org Managing Editor Stacy Jablonski stacy@eyeworld.org Senior Staff Writer/Digital Editor Ellen Stodola ellen@eyeworld.org Senior Staff Writer Liz Hillman liz@eyeworld.org Production Graphic Designer Julio Guerrero julio@eyeworld.org Graphic Design Assistant Susan Steury susan@eyeworld.org Production Manager Cathy Stern cathy@eyeworld.org Contributing Writers Stefanie Petrou Binder, MD Berlin, Germany Vanessa Caceres Bradenton, Florida Rich Daly Arlington, Virginia Lauren Lipuma Washington, D.C. Michelle Stephenson Roanoke, Virginia Senior Contributing Writer Maxine Lipner Nyack, New York Advertising Sales ASCRSMedia 4000 Legato Road Suite 700 Fairfax, VA 22033 703-591-2220 Fax: 703-591-0614 eyeworld@eyeworld.org www.eyeworld.org Paul Zelin paul@eyeworld.org Classified Sales Cathy Stern cathy@eyeworld.org EyeWorld Special Projects and Events Jessica Donohoe jessica@eyeworld.org Shelly Dixon shelly@eyeworld.org Anne Le anne@eyeworld.org ASCRS Publisher: EyeWorld (ISSN 1089-0084) is published monthly by ASCRS Ophthalmic Services Corp., 4000 Legato Road, Suite 700, Fairfax, VA 22033-4055; telephone: 703-591-2220; fax: 703-591-0614. Printed in the U.S. Editorial Offices: EyeWorld News Service, 4000 Legato Road, Suite 700, Fairfax, VA 22033-4055; toll-free: 800-451-1339, 703-591-2220; fax: 703-591-0614; email: eyeworld@eyeworld.org Advertising Offices: ASCRSMedia, 4000 Legato Road, Suite 700, Fairfax, VA 22033-4055; toll-free: 800-451-1339, 703-591-2220; fax: 703-591-0614; email: eyeworld@eyeworld.org Copyright 2018, ASCRS Ophthalmic Services Corp., 4000 Legato Road, Suite 700, Fairfax, VA 22033-4055. All rights reserved. No part of this publication may be reproduced without written permission from the publisher. Letters to the editor and other unsolicited material are assumed intended for publication and are subject to editorial review and acceptance. Subscriptions: Requests should be addressed to the publisher. Annual subscription prices: Individual: 1 year, $120; 2 years, $220; 3 years, $320. Institutional: 1 year, $250; 2 years, $330; 3 years, $425. 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